ABLATION OF ATRIAL INSERTION SITES OF LEFT-SIDED ACCESSORY PATHWAYS IN CHILDREN - EFFICACY AND SAFETY OF TRANSSEPTAL VERSUS TRANSAORTIC APPROACH

Left-sided accessory pathways are a common substrate for supraventricu lar tachycardias in children. A transseptal approach to catheter ablat ion has been primarily advocated in this population because of concern s 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 cons uming, We, therefore, compared the efficacy and safety of the transsep tal vs the transaortic approach in 49 consecutive pediatric patients. In both groups, the atrial insertion site of the accessory pathways wa s 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 c oncealed (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 mit ral regurgitation seen in two patients (one in each group). Two patien ts in the transseptal group had recurrence of tachycardia on follow-up and were successfully ablated by the transaortic method. In this seri es from a single center, a transaortic approach to ablation of left-si ded accessory pathways in children older than 4 years was as effective as a transseptal approach.