Access to the left atrium for delivery of radiofrequency ablation in youngpatients: Retrograde aortic vs transseptal approach

Reported experience with the transseptal approach to the left atrium for de livery of radiofrequency energy in the young patient is limited. To compare two approaches for radiofrequency ablation (RFA) in the left atrium we rev iewed our experience from January 1, 1991, through February 1, 1999, in 154 procedures performed on 136 patients (mean age 12.2 years). The patients w ere grouped by either the retrograde aortic route (R, n = 30) or the transs eptal atrial route (T, n = 106). No significant differences were found in a ge, weight, height, supraventricular tachycardia cycle length, or electroca rdiograph characteristics (manifest vs concealed accessory pathway) between the two approaches. Comparison of the transseptal group to the retrograde aortic group revealed a significant difference in the number of catheters ( mean = 4 R vs 3 T, p < 0.0001), total fluoroscopic time (71.3 min R vs 43.0 min T, p = 0.0007), diagnostic fluoroscopic time (40.2 min R vs 16.6 min T , p < 0.0001), ablation fluoroscopic time (44.7 min R vs 25.3 min T, p = 0. 019), and procedure time (5.0 hours R vs 4.1 hours T, p < 0.0001). No signi ficant difference was found in success rate, number of radiofrequency appli cations, or major complication rate. These data suggest that although outco mes and major complication rates are similar for the two groups, the use of fewer catheters and shorter fluoroscopic times warrant consideration of th e transseptal atrial approach in young patients.