Application of transseptal puncture to radiofrequency catheter ablation in children with left accessory pathway induced paroxysmal supraventricular tachycardia

Abstract

Objective To explore the value of transseptal puncture for left-sided accessory pathway in radiofrequency catheter ablation in children with paroxysmal supraventricular tachycardia(PSVT). Methods Thirty-three patients with PSVT who had underwent radiofrequency catheter ablation in the First Affiliated Hospital, Sun Yat-Sen University from January 2012 to December 2017 were retrospectively analyzed.All the cases were treated by transaortic approach(transaortic group) or transseptal approach(transseptal group). The immediate success rates, total fluoroscopy time and radiation exposure between 2 groups were compared, and the perioperative complications and recurrence rates were observed between 2 groups. Results Thirty-three cases of children were enrolled, 22 cases were male and 11 cases were female.Nineteen cases were treated by transaortic approach(transaortic group), while 18 cases were treated by transseptal approach(transseptal group), including 4 recurrent cases in the transaortic group who were switched to transseptal approach because of previous treatment failure.The age was (10.16±3.06) years and (10.67±2.20) years, and the weight was (37.68±14.28) kg and (37.33±8.64) kg, respectively.There were no significant diffe-rences in age and weight statistics between 2 groups(all P>0.05). The total fluoroscopy time was (20.16±11.41) minutes and (12.56±5.23) minutes, and the median dose of radiation exposure was 67.0 mGy and 33.5 mGy, respectively.The postoperative recurrence rate was 21% (4/19 cases) and 0 (0/18 cases), respectively.There were significant differences in total fluoroscopy time, radiation exposure and recurrence rate statistics between 2 groups(t=2.627, Z=-2.31, χ2=4.249, all P<0.05). No complications were found in both 2 groups. Conclusions It is safe and feasible by transseptal puncture for left-sided accessory pathway in radiofrequency catheter ablation in children with PSVT.Radiofrequency catheter ablation by transseptal approach could significantly reduce the postoperative recu-rrence rate, and should be the first choice for left-side accessory pathway in children. Key words: Child; Paroxysmal supraventricular tachycardia; Transseptal puncture; Left-sided accessory pathway; Catheter ablation