Mid-septal accessory pathway in a young professional athlete: when and how to ablate?

Contact address: Ioan-Alexandru Minciuna, „Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania. E-mail: iaminciuna@gmail.com 1 „Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania 2 Departament of Cardiology-Rehabilitation, Clinical Rehabilitation Hospital, Cluj-Napoca, Romania Abstract: Wolf-Parkinson-White (WPW) syndrome is responsible for 1% of all deaths in athletes. Considering the increased risk of sudden cardiac death (SCD) in athletes compared to general population, a comprehensive risk stratifi cation is crucial. Both American and European guidelines recommend electrophysiology (EP) study for risk assessment and catheter ablation as the fi rst-line treatment in athletes with WPW syndrome. Radiofrequency (RF) catheter ablation is the routine treatment for most accessory pathways (AP). However, cryo-energy ablation is recommended for APs located close to the atrioventricular node, in particular mid-septal and superoparaseptal, because of the increased risk of complete atrioventricular block with RF ablation. Depending on the European or American guidelines, athletes should be granted clearance for competitive sports 1 month after the procedure if free of symptoms and without pre-excitation recurrence on ECG.