Catheter Ablation (WPW)Results over 20 years, to 2026

Summary

Recurrence rate in 2019–2026

Success rate in 2019–2026

In 2019–2026 the recurrence rate was lower than in the two earlier periods at every site: left, septal and right.

Accessory pathway location (manifest, intermittent, concealed)

We divided WPW into three types by how the delta wave appears on the ECG and compared the proportions of accessory pathway locations (left, septal, right). Each patient is counted once (repeat procedures are not counted).

Success and recurrence by type

Concealed pathways were rarely right-sided. I think this finding is not widely known.

When a patient had more than one accessory pathway, each location was counted once (so the location total is slightly larger than the number of patients). Among patients whose type was not recorded, those whose type could be determined from the description of the preprocedural ECG were included in that type; the 12 patients whose type could not be determined were excluded. Our paper on 1,021 ablation procedures (2006–2018) showed the same tendency (see the paper).

Recurrence rate by location and period

Radiofrequency and cryoablation

Accessory pathways are usually treated by burning with radiofrequency (RF). Since 2016, for septal pathways right next to the AV node (the electrical pathway of the heart) and in similar situations, we have also used cryoablation, which treats by freezing. The breakdown of 702 procedures:

"Both" means radiofrequency and cryo were both used in one procedure. Of the 44 procedures with cryo alone, 32 were for septal pathways (others: 10 right, 2 with no location recorded). Because the treated sites differ, success and recurrence rates cannot be compared directly.

Asymptomatic WPW

101 procedures were performed in patients whose delta wave was found by school heart screening or similar and who had no tachycardia (no symptoms). Without retrograde conduction from the ventricle to the atrium over the accessory pathway (AP-VA), the usual WPW tachycardia (atrioventricular reentrant tachycardia) does not occur.

AP-VA by location

• No AP-VA
• AP-VA present

• Left
  1232
• Septal
  619
• Right
  925

The 101 cases are procedure records (98 patients; 3 were treated twice). The 2 cases with two or more pathways are counted at each location, so the location total is slightly larger than 101. AP-VA was determined from the "WPW with AP_VA" / "WPW without AP_VA" fields in the procedure records; when these were blank, from the record of VA conduction (via the accessory pathway) in the electrophysiology study.

Tables

Procedures

Recurrences

Recurrence rate (%)

Successful procedures

Success rate (%)

* The "All" row is the sum of left, septal and right (success and recurrence rates = successes or recurrences ÷ procedures). Procedures with more than one pathway are counted at each location, so "All" is slightly larger than the number of procedures (702).

Methods: from our department's ablation database, we counted all 702 procedures (643 patients) treated as WPW between January 1, 2006 and September 26, 2026. Repeat procedures in the same patient were each counted as one procedure. Success means that conduction over the accessory pathway was eliminated at the end of the procedure, or that symptoms improved. Recurrence is the number recorded as recurrence in the database (the length of follow-up was not standardized).

Related pages

• Catheter Ablation (all procedures)Age and weight distribution, success and recurrence rates, results by arrhythmia
• AVNRT resultsTypical vs. atypical, radiofrequency vs. cryo
• PVC/NSVT resultsProcedures and recurrence by site: RVOT, RV inflow and others
• Outcomes of 1,021 procedures (Heart Rhythm 2020)Our paper on 1,021 pediatric ablation procedures at our hospital