Catheter Ablation of Left-Sided Accessory Pathways with and Without Fluoroscopic Guidance in Children: No Difference in Success Rate, Recurrence Rate, and Complication Rate

Background: The aim of this study was to compare the efficacy and safety of catheter ablation of left-sided accessory pathways (APs) in children performed with and without fluoroscopy using explicitly 3D electroanatomical mapping systems.

Method: A total of 58 consecutive children with left-sided accessory pathway catheter ablation between July 2016 and September 2021 were analyzed retrospectively.

Results: Mean age was 11.6 years (range: 5.5–17 years) and 36 (62%) patients were male. Forty patients (68.9%) presented with manifest APs. The location of APs were lateral in 21 patients, posterolateral in 14, posterior in 10, posteroinferior in 3, anterolateral in 3, inferior in 2, paraseptal in 2, inferoparaseptal 1, inferoposteroseptal 1, and anterior in 1. A total of 64 substrates in 58 patients were ablated during this period of time. Five patients had ≥2 substrates. We accessed the left atrium via transseptal puncture in 47 patients (81%) and via patent foramen ovale in nine patients. We did retrograde ablation in six patients and in the coronary sinus in four. Cryoablation was applied to only two patients because of proximity of his bundle and ablation in the coronary sinus separately. Mean procedure time was 193 minutes (range: 81–323 minutes). No X-ray was handled in 14 patients. Limited fluoroscopy was used in 44 patients and mean fluoroscopy time was 6 minutes (range: 0.2–29.7). The mean total radiation dose per body surface area was 1,092.9 mGy (range: 4.1–8,018 mGy). Radiofrequency ablation was delivered with 24.3 W (5–40 W) at 49.4°C (39–60°C). The acute success rate was 98.4% (63/64), with a recurrence rate of 1.5% (1/64) at a mean follow-up of 32.3 (range: 1–62) months. No ablation-related complication occurred. Comparison of 14 patients ablated with no fluoroscopy to the 44 patients ablated with the help of fluoroscopy showed no statistically difference in terms of acute success rate, recurrence rate and complication (p > 0.05). The procedure time was significantly lower in the group of patients with no fluoroscopy (p = 0.0001).

Conclusion: Catheter ablation of left-sided APs with zero fluoroscopy in children seems to be as safe and effective with high success, low recurrence, and low complication rate compared with those performed with fluoroscopy.

Publication History

Article published online:
12 February 2022