Catheter Ablation of Right-Sided Accessory Pathways Limited-Zero Fluoroscopy in Children: Single-Center Experience

Background: Catheter ablation with limited fluoroscopy via 3D electro-anatomical technology has been performed commonly in children with atrial or ventricular tachycardia. The aim of this study was to evaluate the effectiveness and safety of catheter ablation of right-sided accessory pathways (APs) in children.

Method: A total of 57 children treated with right-sided accessory pathway ablation between July 2016 and September 2022 were evaluated retrospectively.

Results: The mean age was 12.2 ± 3.5 years and 34 (59.6%) patients were male. A history of previous ablation was positive in 12/51 patients. Thirty-seven (70.2%) patients presented with manifest APs. A total of 64 substrates of the right AP in 57 patients were ablated during this period of time. Seven patients had ≥2 substrates. Two patients had a left and right AP. The location of APs were superoparaseptal (parahisian) in 15, superior in 4, anterosuperior in 3, anterior in 11, anteroinferior in 6, inferior in 2, posteroseptal in 14 and midseptal in 9 patients. Conduction property was antegrade-only conduction in 10/64 substrates, retrograde-only 17/64 and both in 37/64. We did ablation in one patient retrogradely via aorta and in another patient under the tricuspid valve in the right ventricle. Energy for ablation was radiofrequency in 35, cryoablation in 22 and both in 5 substrates. The mean procedure time was 210.8 ± 71.3 min. No X-ray was used in 20 (35.1%) patients. Limited fluoroscopy was used in 37 (64.9%) patients and median fluoroscopy time was 3.5 ± 5.1 min. The mean total radiation dose per body surface area was 725.2 ± 1,527.4 mGy cm²/m² and the acute success rate was 96.8% (62/64), with a recurrence rate of 10.9% (7/64) at a mean follow-up of 36.1 ± 22.3 months. No ablation-related complications occurred. Comparison of 20 patients ablated with no fluoroscopy to the 37 patients ablated with the help of fluoroscopy showed no statistically difference in terms of acute success rate and recurrence rate (p > 0.05). The procedure time was significantly lower in the patients with no fluoroscopy (p = 0.002).

Conclusion: Catheter ablation of right-sided APs with limited/zero fluoroscopy in children seems to be fast, safe and effective with high success rate and relatively low recurrence rate.

Publication History

Article published online:
28 January 2023