Background: Catheter ablation with limited fluoroscopy via 3D electro-anatomical technology has
been performed commonly in children with atrial or ventricular tachycardia. The aim
of this study was to evaluate the effectiveness and safety of catheter ablation of
right-sided accessory pathways (APs) in children.
Method: A total of 57 children treated with right-sided accessory pathway ablation between
July 2016 and September 2022 were evaluated retrospectively.
Results: The mean age was 12.2 ± 3.5 years and 34 (59.6%) patients were male. A history of
previous ablation was positive in 12/51 patients. Thirty-seven (70.2%) patients presented
with manifest APs. A total of 64 substrates of the right AP in 57 patients were ablated
during this period of time. Seven patients had ≥2 substrates. Two patients had a left
and right AP. The location of APs were superoparaseptal (parahisian) in 15, superior
in 4, anterosuperior in 3, anterior in 11, anteroinferior in 6, inferior in 2, posteroseptal
in 14 and midseptal in 9 patients. Conduction property was antegrade-only conduction
in 10/64 substrates, retrograde-only 17/64 and both in 37/64. We did ablation in one
patient retrogradely via aorta and in another patient under the tricuspid valve in
the right ventricle. Energy for ablation was radiofrequency in 35, cryoablation in
22 and both in 5 substrates. The mean procedure time was 210.8 ± 71.3 min. No X-ray
was used in 20 (35.1%) patients. Limited fluoroscopy was used in 37 (64.9%) patients
and median fluoroscopy time was 3.5 ± 5.1 min. The mean total radiation dose per body
surface area was 725.2 ± 1,527.4 mGy cm2/m2 and the acute success rate was 96.8% (62/64), with a recurrence rate of 10.9% (7/64)
at a mean follow-up of 36.1 ± 22.3 months. No ablation-related complications occurred.
Comparison of 20 patients ablated with no fluoroscopy to the 37 patients ablated with
the help of fluoroscopy showed no statistically difference in terms of acute success
rate and recurrence rate (p > 0.05). The procedure time was significantly lower in the patients with no fluoroscopy
(p = 0.002).
Conclusion: Catheter ablation of right-sided APs with limited/zero fluoroscopy in children seems
to be fast, safe and effective with high success rate and relatively low recurrence
rate.
