Transseptal Approach Versus Transaortic Approach for Catheter Ablation of Left-Sided Accessory Pathways in Children

Area of Science:

• Pediatric Cardiology
• Electrophysiology
• Interventional Cardiology

Background:

• Catheter ablation is the recommended treatment for supraventricular tachycardia caused by left-sided accessory pathways (APs) in children.
• Comparing transseptal (TS) and aortic (TA) approaches is crucial for optimizing pediatric AP ablation.

Purpose of the Study:

• To compare the safety and efficacy of the transseptal (TS) and aortic (TA) approaches for catheter ablation of left-sided accessory pathways (APs) in pediatric patients.
• To evaluate success rates, recurrence, complications, procedure time, and radiation dose for both approaches.

Main Methods:

• A randomized study included pediatric patients (<18 years) with left-sided APs undergoing ablation.
• Patients were assigned to either the TS or TA group, with a follow-up period of 22 months.
• Key endpoints included ablation success, recurrence, complications, procedure duration, and radiation exposure.

Main Results:

• Both TS and TA approaches demonstrated high success rates (100% vs. 97.56%) with no significant difference.
• Procedure times were similar overall, but TS was faster for APs in the left posterior septum (LPS) or left posterior lateral (LPL) areas (p < 0.01).
• The TA group had significantly lower radiation exposure (0 mGy) compared to the TS group (p < 0.001). No recurrences or complications were observed in either group post-ablation.

Conclusions:

• Both transseptal and aortic approaches are safe and effective for pediatric catheter ablation of left-sided accessory pathways.
• The aortic approach is preferred due to zero radiation and ease of mastery.
• The transseptal approach is recommended for trained professionals, particularly for LPS/LPL accessory pathways, or as an alternative for patients with aortic lesions or failed TA.