Arrhythmias & electrophysiologyCohort study
An integrated approach to radiofrequency ablation of para-Hisian accessory pathways in paediatric patients
- single-centre retrospective study
Authors' conclusion
Our integrated ablation strategy effectively addresses the unique challenges of paediatric PHAP ablation, achieving durable efficacy and high procedural safety.
Study context
- Population
- Paediatric patients undergoing para-Hisian accessory pathway (PHAP) ablation, January 2023 to September 2025paediatric patients (median age 10 years)
- Participants
- 41 patients
Main finding
As reported in the abstract
Acute success and permanent complications
- All 41 cases achieved acute success with no permanent complications
Observational data: associations, not effects.
Further findings
Recurrence among manifest pathways, pace-mapping added to activation mapping vs not
- Recurrence among manifest pathways, pace-mapping added to activation mapping vs not: hypothesis-generating trend that did not reach statistical significance (P = .056)
Mechanical pathway block during mapping
- Mechanical pathway block during mapping
- 43.9% (18/41)
Stable ablation with subvalvular retroflexion
- Subvalvular retroflexion enabled stable ablation
- 90.2% (37/41)
- patients <10 kg required supravalvular approaches
- 3
- concealed pathway successfully ablated from the non-coronary cusp
- one
Recurrence · median 19-month follow-up
- Recurrence
- 7.4% (3/41)
Predictors of recurrence (univariate analysis)
- Higher recurrence risk for pathways with a W-pattern in lead V1 and for those in the superior mid-septal region
- univariate analysis
Original publication
An integrated approach to radiofrequency ablation of para-Hisian accessory pathways in paediatric patients. Heart Rhythm. Published 8 January 2026. doi:10.1016/j.hrthm.2026.01.002
Summarised from the published abstract; every number is checked against it