Low incidence of significant valvar insufficiency following retrograde aortic radiofrequency catheter ablation in young patients

The incidence of significant valvar insufficiency at late (>6 month) follow -up was retrospectively evaluated in 27 young patients (age 4.0-18.0 years) undergoing 29 ablation procedures via the retrograde aortic approach for l eft-sided accessory connections in whom pre-ablation and post-ablation echo cardiograms were available for review. Valvar insufficiency was graded usin g color flow techniques as absent, trivial, mild, moderate, or severe by bl inded reviewers. Ablation was acutely successful via the retrograde approac h in 25 of 29 procedures among these 27 patients. Successful ablation was u ltimately achieved in all 27 patients. At baseline, 7 patients had evidence of trivial or mild mitral insufficienc y, and no patient had aortic insufficiency. Three patients had evidence of impaired left ventricular systolic performance in the presence of manifest pre-excitation. At follow-up, pre-existing mitral insufficiency resolved in 5/7 patients, and persisted in 2 patients. New mitral insufficiency was ev ident in 3 patients, and new aortic insufficiency was transiently evident i n 1 patient following ablation (all trivial). Institutional experience (mea n rank 10 cases vs. 33 cases, p < .0005), and lower patient weight (29.7 vs . 56.3 kilograms, p = .01) were the only factors associated with the develo pment of new valvar insufficiency. Valvar insufficiency could not be detect ed by careful auscultation in any patient and was deemed clinically insigni ficant in all patients. We conclude that ablation of left-sided accessory connections can be perfor med via the retrograde aortic approach without creating clinically signific ant valvar insufficiency.