Location of accessory pathways in WPW: What and how should we ablate

Abstract

Treatment of accessory pathways has evolved substantially in the last decades, leading to radio-frequency catheter ablation as the therapeutic technique of choice in this setting. Some of the clues for its high rate of success and its low morbidity and mortality indices are a deeper knowledge of accessory pathways characteristics, the development of advanced technology for mapping and ablation, and the gained experience in the field. This chapter intends to be a guide that helps understand variability in accessory pathway characteristics along the atrioventricular junction in order to design the appropriate approach for mapping and correctly identify the site of most probable ablation success. The result combines the most relevant data available in literature, from renowned experts in the field, and our own experience. Important aspects as anatomy of accessory pathways or their electrocardiographic and electrophysiologic features are specifically discussed for the different regions along the atrioventricular junction. Moreover, the text summarizes the most important mapping criteria currently used to guide ablation of atrioventricular accessory pathways. Finally, we provide relevant clinical considerations that routinely guide our daily clinical practice when dealing with patients presenting with atrioventricular accessory connections.