Ablation of Atrial Insertion Sites of Left-Sided Accessory Pathways in Children: Efficacy and Safety of Transseptal Versus Transaortic Approach

Abstract

Left-sided accessory pathways are a common substrate for supraventricular tachycardias in children. A transseptal approach to catheter ablation has been primarily advocated in this population because of concerns regarding vascular injury, aortic, and mitral valvular damage using the transaortic approach via retrograde femoral arterial cannulation. However, the transaortic approach is simpler and may be less time consuming. We, therefore, compared the efficacy and safety of the transseptal vs the transaortic approach in 49 consecutive pediatric patients. In both groups, the atrial insertion site of the accessory pathways was targeted. Postprocedure two-dimensional and Doppler echocardiograms were obtained in all patients. The transseptal and transaortic groups were similar in age (15.8 +/- 1.6 vs 13.5 +/- 3.6 p NS), manifest vs concealed (9/5 vs 20/15), and number of radiofrequency lesions (4 vs 6). Fluoroscopy time was significantly shorter in the transaortic group (33 vs 58 min, p < 0.05). The only evident complications were mild mitral regurgitation seen in two patients (one in each group). Two patients in the transseptal group had recurrence of tachycardia on follow-up and were successfully ablated by the transaortic method. In this series from a single center, a transaortic approach to ablation of left-sided accessory pathways in children older than 4 years was as effective as a transseptal approach.

Ablação por cateter com radiofreqüência de vias acessórias esquerdas por abordagem transeptal

“…With respect to children two studies stand out: Vora et al 12 obtained a 100% success rate in the ablation of left APs in their atrial insertions using the RA access in 36 patients and the TS access in thirteen. They reported a shorter FT for the RAA technique (p = 0.05) 12 .…”

“…Overall the studies suggest that the differences found between the techniques may be related to the learning curve and to the experience of the operator, rather than to the specifi c technique used 12,13 . When we began this study the group was more experienced with procedures via RA, and only one operator had received training in TS puncture.…”

“…They reported a shorter FT for the RAA technique (p = 0.05) 12 . Law et al 13 studied 136 children and obtained shorter FT, TT and smaller numbers of catheters used with the TSA technique, but without differences relative to success rates and complications 13 .…”

“…Some studies compared both techniques in a retrospective manner [5][6][7][8][9][10][11][12][13] . Natale et al 5 achieved a higher success rate in TSA ablation (100% as compared to 88%; p < 0.03) in a series with 80 patients.…”

“…However, with the advancements in ablation procedures for atrial arrhythmias, markedly for atrial fi brillation, the transeptal puncture has been incorporated to the routine of electrophysiologists. Retrospective studies have compared these two techniques and reported controversial results, usually related to the experience of each group [5][6][7][8][9][10][11][12][13] .…”