PO-03-159 TRANSSEPTAL VERSUS RETROGRADE AORTIC ABLATION OF LEFT-SIDED ACCESSORY PATHWAYS IN PEDIATRIC PATIENTS IN THE MODERN ERA

Abstract

In the modern era of widespread use of three-dimensional electroanatomical mapping and minimal fluoroscopy, a comparison of the advantages and disadvantages of transseptal (TS) and retrograde aortic (RA) approaches to left-sided accessory pathway ablation in pediatrics has not been performed. The purpose of this study is to evaluate procedural safety and outcomes of catheter ablation via TS versus RA catheterization in pediatric patients with structurally normal heart and left-sided accessory pathways. This is a retrospective single-center chart review of pediatric patients from 2012-2021 at a free-standing children's hospital. This study was approved by our Institution Review Board. Inclusion criteria include age 0-21 years with a structurally normal heart. Exclusion criteria include significant structural heart disease and patients in whom ablation was not attempted. Outcomes assessed include procedural success, complications, recurrence, fluoroscopy exposure, and total ablation time. A total of 161 patients across 160 procedures met inclusion criteria. The median age was 13.5 years ([IQR] 9 - 16) and 40.4% (n=65) were female with median weight of 53.1kg (28.5-66.0). TS was performed in 58.1% (n=93) of procedures, while RA catheterization was performed in the other 41.9% (n=67). There were no significant differences in age, gender, weight, body surface area, or indication for ablation between either approach. Ablation success was achieved in 100.0% (n=67) of TS patients compared to 96.8% (n=90) of RA patients. There were no complications in the TS group and 4 (4.3%) complications in the RA group, with no major complications or mortality for either group. Overall, fluoroless ablation was achieved 79 procedures (50.6%), with zero fluoroscopy achieved in significantly more RA cases compared to TS (70.8% vs 23.9% p<0.001). For patients where follow-up clinic visit data was available (n=98), the median follow-up time was 31.2 (7-83) months. Recurrence was observed in 8 (11.9%) TS patients versus 14 (15.1%) RA patients (p=0.55). In the modern era with three-dimensional mapping and low fluoroscopy, both transseptal and retrograde aortic approaches to left-sided AP ablation in pediatric patients remain equivocally safe and efficacious. Although zero fluoroscopy was achieved in significantly more RA cases, nonsignificant increases in complications and recurrence were also observed in the RA approach compared to TS.