Background: The aim of this study was to assess long-term efficacy and safety of empirical slow pathway (ESP) ablation in pediatric and adult patients with a special interest in patients without dual AV nodal physiology (DAVNP). Methods: A retrospective single-center review of patients who underwent ESP ablation between December 2014 and September 2022 was performed. Follow-up included telephone communication, letter questionnaire and outpatient presentation. Recurrence was based on typical symptoms. Results: 115 patients aged 6–81 years (median age 36.3 years, 59.1% female; 26 pts < 18 years) were included. A typical history was present in all patients (100%), an ECG documentation of narrow complex tachycardia in 97 patients (84%). Patients were divided into three groups: Group 1 without DAVNP (n = 23), Group 2 with AH jump (n = 30) and Group 3 with AH jump and at least one AV nodal echo beat (n = 62). No permanent AV block was observed. During a median follow-up of 23.6 ± 22.7 months, symptom recurrence occurred in 7/115 patients (6.1%) with no significant difference between the groups (p = 0.73, log-rank test). Symptom recurrence occurred significantly more often in patients without (5/18 patients; 27%) as compared to patients with ECG documentation (2/97 patients; 2.1%; p = 0.025). No correlation between age and success rate was found (p > 0.1). Conclusions: ESP ablation is effective and safe in patients with non-inducible AVNRT. Overall, recurrence of symptoms during long-term follow-up is low, even if no DAVNP is present. Tachycardia documentation before the EP study leads to a significantly lower recurrence rate following ESP ablation.

Background: Data on ultrasound-guided vascular access (UGVA) to reduce vascular access complications in adult congenital heart disease (ACHD) patients undergoing catheter ablation (CA) on uninterrupted oral anticoagulation (OAC) are limited. Objective: Comparison of UGVA to a standard approach with regard to vascular access complications in ACHD patients. Methods: We retrospectively analyzed 477 consecutive ACHD patients (52% male, mean age 46 ± 14 years) with simple ( n = 166), moderate ( n = 133), and complex ( n = 178) congenital heart disease (CHD) who underwent 639 CA procedures for atrial tachycardia or fibrillation between 2014 and 2024. UGVA (243 patients, 271 ablations) was compared to a conventional approach (234 patients, 368 ablations) regarding vascular access complications under uninterrupted OAC (DOAC or VKA). Results: Access was obtained via the femoral vein ( n = 321), both femoral vein and artery ( n = 311), or jugular vein with femoral artery ( n = 7). UGVA significantly reduced overall vascular access complications compared to the standard approach (4.1% vs. 13.5%; p < 0.001). Major complications occurred only in the conventional group ( n = 4; AV fistula = 2, retroperitoneal hematoma = 2; p = 0.086). Minor complications—hematomas > 5 cm, small AV fistulas treated conservatively, or pseudoaneurysms treated by compression or ultrasound-guided thrombin injection—were also significantly lower with UGVA (4.1% vs. 12.5%; p < 0.001). Conclusions: UGVA significantly decreases vascular access complications in ACHD patients undergoing CA on uninterrupted OAC and may be advantageous for routine use in clinical practice.

We describe an unusual case of focal atrial tachycardia (FAT) from the left inferior pulmonary vein (PV) in a 12- year old boy treated successfully by high power short duration (HPSD) ablation. The patient was referred to our center for ablation of incessant FAT with recurrent transient degeneration into atrial fibrillation. The electrophysiological study revealed FAT with a micro-reentrant like activation from the left inferior PV. To reduce the risk of complications to surrounding structures, isolation of the left pulmonary veins was performed using HPSD (65 W, 6-15 s) ablation. During a follow-up period of 12 months, the patient remained in stable sinus rhythm.