Catheter Ablation of Left-Sided Accessory Pathways in Small Children

Rami Fogelman Cardiology Institute, The Schneider Children’s Medical Center of Israel, Sackler School of Medicine, Tel Aviv University, Petach Tiqva, Israel Einat Birk Cardiology Institute, The Schneider Children’s Medical Center of Israel, Sackler School of Medicine, Tel Aviv University, Petach Tiqva, Israel Tamir Dagan Cardiology Institute, The Schneider Children’s Medical Center of Israel, Sackler School of Medicine, Tel Aviv University, Petach Tiqva, Israel Michal Fogelman Cardiology Institute, The Schneider Children’s Medical Center of Israel, Sackler School of Medicine, Tel Aviv University, Petach Tiqva, Israel Tom Einbinder Cardiology Institute, The Schneider Children’s Medical Center of Israel, Sackler School of Medicine, Tel Aviv University, Petach Tiqva, Israel Elchanan Bruckheimer Cardiology Institute, The Schneider Children’s Medical Center of Israel, Sackler School of Medicine, Tel Aviv University, Petach Tiqva, Israel Moshe Swissa Cardiology Institute, Kaplan Medical Center, Rehovot. The Hebrew University, Jerusalem, Rehovot, Israel

Background: Accessory pathways (AP) are a common cause for supraventricular tachycardia in small children. A trans-septal puncture (TSP) is commonly used for ablation of left-sided APs however, it may be challenging in small children. The aim of this study is to assess the efficacy and safety of a trans-septal approach RF ablation of left-sided APs in children weighing less than 30Kg.

Methods: Retrospective chart review of all children who underwent catheter ablation of APs in our institution since 06/2002. A TSP approach guided by transesophageal echocardiography [TEE] and fluoroscopy was used for left atrial access.

Results: Of 658 children who underwent RF ablation for SVT, 86 children [43 male] had a left-sided AP [manifest in 53%] and weighed less than 30kg. Mean age and body weight were 7.6±1.9 years and 24.0±4.2 kg, respectively. TSP was performed in all cases. The acute success rate was 98.8% (85/86), with a recurrence rate of 2.4% (2/85) during a mean follow-up of 66.2±42.7 (9.1-184.2) months. The mean procedure time and fluoroscopy time were significantly lower for the 3DS (n=24) group compared to the standard fluoroscopy (n=62) group (131±41 (55-262) minutes and 2.4±1.5 (1-6) minutes versus 164±51 (62-249) minutes and 27.1±13.3 (8.3-77) minutes, p< 0.001, respectively). There were no ablation-related complications.

Conclusions: RF ablation of left-sided APs using TSP approach in small children had an excellent efficacy and safety profile. The use of 3DS significantly reduces the procedure and fluoroscopy time.