Radiofrequency ablation of right-sided accessory pathways in pediatric patients

Right free-wall and septal accessory pathways encompass the full spectrum of accessory pathway electrophysiology and are situated in complex anatomical arrangements. Understanding this diversity of physiology is necessary for the successful and safe elimination of these connections with transcatheter radiofrequency ablation. When radiofrequency catheter ablation of these pathways is attempted in children, anatomical relationships often become more complex, and spatial constraints require more adaptive techniques than in adults. It is clear that considerable progress has been made with radiofrequency catheter ablation, such that it is now first-line therapy for most children who have been diagnosed with one of the broad spectrum of clinical manifestations that result from the presence of these accessory connections. This review will discuss how accessory pathway electrophysiology and anatomy impact the clinical syndromes observed in children, and how these factors, as well as others particular to children, determine the approach, results and potential long-term consequences of radiofrequency catheter ablation of right-sided accessory pathways in the pediatric population.