Left-sided Accessory Pathway Research Articles

Wolff Parkinson White Syndrome with Rheumatic Mitral Stenosis: Double Trouble – Single Solution

WPW syndrome with rheumatic mitral stenosis is a rare and deadly combination. We report a patient with the above combination, presenting with drug-refractory antidromic tachycardia due to left atrial flutter and marked dyspnea. She underwent successful radiofrequency ablation of left-sided accessory pathway, left atrial flutter, and percutaneous mitral commissurotomy in a single sitting.

Two Arrhythmias, One Diagnosis, All from Surface ECGs

A 48-year-old male with known supraventricular tachycardia presented with wide complex tachycardia and he was cardioverted. The patient was initially diagnosed with both ventricular tachycardia and supraventricular tachycardia. After reviewing electrocardiograms, a correct diagnosis of orthodromic atrioventricular reciprocating tachycardia with left-sided accessory pathway was made which was confirmed and successfully ablated in subsequent electrophysiological study. Not all wide complex tachycardias are ventricular tachycardia. If the rate of narrow complex supraventricular tachycardia becomes slower with the development of a bundle branch block, it is diagnostic for the presence and participation of the ipsilateral accessory pathway, which is called Coumel’s law

Ablation of persistent atrial fibrillation based on atrial electrogram duration map: methodology and clinical outcomes from the AEDUM pilot study

Abstract Background Catheter ablation of persistent atrial fibrillation (PsAF) represents a challenge for the electrophysiologist and there are still divergences regarding the best ablative approach to adopt. Objectives Create a new map of the duration of atrial bipolar electrograms (Atrial Electrogram DUration Map, AEDUM) to recognize a functional substrate during sinus rhythm and guide a patient-tailored ablative strategy for PsAF. Methods 40 PsAF subjects were assigned in a 1:1 ratio to either for PVI alone (Group B1) or PVI+AEDUM areas ablation (Group B2). A cohort of 15 patients without AF history undergoing left-sided accessory pathway ablation was used as a control group (Group A). In all patients, voltage and AEDUM maps were created during sinus rhythm. The minimum follow-up was 12-months, with rhythm monitoring via 48-h ECG Holter or by implantable cardiac device. Results Electrogram (EGM) duration was higher in Group B than in Group A (49±16.2ms vs 34.2±3.8ms; p-value<0.001). In Group B the mean cumulative AEDUM area was 21.8±8.2cm2; no difference between the two subgroups was observed (22.3±9.1cm2 vs 21.2±7.2cm2; p-value=0.45). The overall bipolar voltage recorded inside the AEDUM areas was lower than in the remaining atrial areas [median:1.30mV (IQR:0.71–2.38mV) vs 1.54mV (IQR:0.79–2.97mV); p-value:<0.001)]. Low voltage areas (<0.5mV) were recorded in three (7.5%) patients in Group B. During the follow-up [median 511 days(376-845days)] patients who underwent PVI-only experienced more AF recurrence than those receiving a tailored approach (65% vs 35%; p-value=0.04). Conclusions All PsAF patients exhibited AEDUM areas. An ablation approach targeting these areas resulted in a more effective strategy compared with PVI only.AEDUM mapAEDUM map and lesion set

Evaluation of T-wave memory after accessory pathway ablation in pediatric patients with Wolff-Parkinson-White syndrome.

T-wave memory (TWM) is a rare cause of T-wave inversion (TWI). Alterations in ventricular activation due to abnormal depolarization may cause repolarization abnormalities on the ECG, even if myocardial conduction returns to normal. These repolarization changes are defined as TWM. In our study, we aimed to determine the frequency of TWM development and the predictors affecting it in the pediatric population who underwent accessory pathway (AP) ablation due to Wolff-Parkinson-White (WPW) syndrome. The data of patients with manifest AP who underwent electrophysiological studies and ablation between 2015 and 2021 were retrospectively analyzed. The study included 180 patients who were under 21 years of age and had at least one year of follow-up after ablation. Patients with structural heart disease, intermittent WPWs, recurrent ablation, other arrhythmia substrates, and those with less than one-year follow-up were excluded from the study. The ECG data of the patients before the procedure, in the first 24h after the procedure, three months, and in the first year were recorded. The standard ablation technique was used in all patients. Postprocedure TWM was observed in 116 (64.4%) patients. Ninety-three patients (51.7%) had a right-sided AP, and 87 patients (48.3%) had a left-sided AP. The presence of posteroseptal AP was found to be significantly higher in the group that developed TWM. Of these patients, 107 (93.1%) patients showed improvement at the end of the first year. Preprocedural absolute QRS-T angle, postprocedural PR interval, and right posteroseptal pathway location were identified as predictors of TWM. The development of TWM is particularly associated with the right-sided pathway location, especially the right posteroseptal pathway location. The predictors of TWM are the preprocedural QRS-T angle, the postprocedural PR interval, and the presence of the right posteroseptal AP.

Ablation of accessory pathways in different anatomic locations using focal pulsed field ablation

BackgroundAblation of accessory pathways (APs) is the cornerstone for treatment of patients with Wolff-Parkinson-White syndrome and manifestation of atrioventricular reentrant tachycardia. Pulsed field ablation (PFA) is a new type of nonthermal energy source delivered to the underlying tissue via the ablation catheter and used for ablation of arrhythmic substrates. ObjectiveThe purpose of this study was to determine the efficiency and long-term outcome of ablation of APs of different localizations using a focal pulsed electrical field. MethodsElectrophysiological study was performed in patients with indication for AP ablation. An ablation catheter was used to map the position of AP insertion. Pulsed electric field was delivered through a standard ablation catheter. In left-sided APs, the first ablation attempt was within the coronary sinus (CS). Patient follow-up was scheduled 1–3 months after the ablation. Additional check-up was performed after 6 and 12 months. ResultsFourteen 14 patients (3 pediatric) were treated. Termination of AP conduction was achieved in all procedures. The cohort consisted of 3 right free wall, 3 posteroseptal, and 8 left-sided APs. Ablation through CS was successfully used in 7 of 8 patients with left-sided APs. No complications were reported. Median follow-up was 5.5 months. Conduction recurrence through AP was documented in 1 patient. ConclusionFocal PFA for AP shows promising results in terms of efficacy and safety. A high rate of successful termination of left-sided APs by ablation within CS may represent a new standard approach. The safety and efficacy profile of PFA seems to be transferable to the pediatric population.

A rare presentation of Ebstein's anomaly: left-sided accessory pathway and tricuspid stenosis.

A rare presentation of Ebstein's anomaly: left-sided accessory pathway and tricuspid stenosis.

Catheter ablation of supraventricular tachycardia and atrial flutter with no or minimal use of fluoroscopy: the initial experience of a single Bulgarian center

Introduction: Catheter ablation (CA) is an established therapy for most arrhythmias. Non-fl uoroscopic three-dimensional (3D) electroanatomic mapping systems allow ablation of supraventricular tachycardia (SVT) and atrial fl utter (AFL) with zero or near-zero fl uoroscopy (ZF/NZF). The current study aims to report our initial experience with ZF/NZF in SVT or AFL CA. Material and methods: We conducted a single-center prospective registry enrolling consecutive patients referred for CA of SVT or AFL. ZF/NZF CA was attempted in all patients using a commercially available 3D mapping system. Fluoroscopy use was allowed at any point of the procedure. Procedural characteristics and long-term outcome were analyzed. The learning curve effect was also studied. Results: Sixty-three patients (age 53.5 ± 14.1, 57% males) with SVT or AFL were enrolled. According to arrhythmia type typical AVNRT was diagnosed in 36 (57.1%) cases, right atrial fl utter in 25 (39.7%) cases, left-sided accessory pathway in 1 (1.6%) and focal right atrial tachycardia in 1 (1.6%) case. Three patients (4.8%) had two arrhythmia substrates. The procedure was performed with ZF in 49/63 cases (77.8%), while NZF was necessary in 14 (22.2%) patients with a fl uoroscopy time of 220 ± 169 sec and a dose-area product of 7556 ± 5886 mGy*cm2. Median procedural time was 88 (IQR 25-75 percentile 71.5-116) min with 22 (IQR 25-75 percentile 16-31) min of mapping time. Acute procedural success was accomplished in all patients with no periprocedural complications. Over a follow-up of 12 ± 3 months, all patients remained arrhythmia-free. There was a learning curve effect with a signifi cant reduction of procedural time (P = 0.025) and a signifi cant difference (P = 0.019) in the rate of fl uoroscopy use among different periods of the study duration. Conclusion: ZF/NZF CA of SVT and AFL is associated with high effi cacy and safety. Entirely fl uoroless CA can be performed in the vast majority of patients. It is a feasible approach associated with a detectable learning curve effect. 

Ablation of persistent atrial fibrillation based on atrial electrogram duration map: methodology and clinical outcomes from the AEDUM pilot study

BackgroundCatheter ablation of persistent atrial fibrillation (PsAF) represents a challenge for the electrophysiologist and there are still divergences regarding the best ablative approach to adopt. Create a new map of the duration of atrial bipolar electrograms (Atrial Electrogram DUration Map, AEDUM) to recognize a functional substrate during sinus rhythm and guide a patient-tailored ablative strategy for PsAF.MethodsForty PsAF subjects were assigned in a 1:1 ratio to either for PVI alone (Group B1) or PVI+AEDUM areas ablation (Group B2). A cohort of 15 patients without AF history undergoing left-sided accessory pathway ablation was used as a control group (Group A). In all patients, voltage and AEDUM maps were created during sinus rhythm. The minimum follow-up was 12 months, with rhythm monitoring via 48-h ECG Holter or by implantable cardiac device.ResultsElectrogram (EGM) duration was higher in Group B than in Group A (49±16.2ms vs 34.2±3.8ms; p-value<0.001). In Group B the mean cumulative AEDUM area was 21.8±8.2cm2; no difference between the two subgroups was observed (22.3±9.1cm2 vs 21.2±7.2cm2; p-value=0.45). The overall bipolar voltage recorded inside the AEDUM areas was lower than in the remaining atrial areas [median: 1.30mV (IQR: 0.71–2.38mV) vs 1.54mV (IQR: 0.79–2.97mV); p-value: <0.001)]. Low voltage areas (<0.5mV) were recorded in three (7.5%) patients in Group B. During the follow-up [median 511 days (376–845days)] patients who underwent PVI-only experienced more AF recurrence than those receiving a tailored approach (65% vs 35%; p-value= 0.04).ConclusionsAll PsAF patients exhibited AEDUM areas. An ablation approach targeting these areas resulted in a more effective strategy compared with PVI only.Graphical

A visualized left-sided accessory pathway away from the mitral annulus using open window mapping with the early meets late algorithm.

A visualized left-sided accessory pathway away from the mitral annulus using open window mapping with the early meets late algorithm.

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

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.

Long-term follow-up in preschool children after radiofrequency catheter ablation of arrhythmias.

Radiofrequency ablation (RFA) is the standard method of treatment for tachyarrhythmias in school children, and it leads to complete recovery in children without structural heart disease. However, RFA in young children is limited by the risk of complications and unstudied remote effects of radiofrequency lesions. To present the experience of RFA of arrhythmias and the results of follow-up of younger children. RFA procedures (n=255) were performed in 209 children with arrhythmias from 0 to 7 years old. The arrhythmias were presented with atrioventricular reentry tachycardia withWolff-Parkinson-White(WPW) syndrome (56%), atrial ectopic tachycardia (21.5%), atrioventricular nodal reentry tachycardia (4.8%), and ventricular arrhythmia (17.2%). The overall effectiveness of RFA, considering the repeated procedures performed due to the primary ineffectiveness and recurrencies, was 94.7%. There was no mortality associated with RFA in patients, including young patients. All cases of "major" complications are associated with RFA of the left-sided accessory pathway and tachycardia foci and are represented by the mitral valve damage in three patients (1.4%). Tachycardia and preexcitation recurred in 44 (21%) patients. There was a correlation between recurrences and parameters of RFA (odds ratio 0.894; 95% confidence interval: 0.804-0.994; p=.039). Reducing the maximum power of effective applications in our study increased the risk of recurrence. The use of the minimum effective parameters of RFA in children reduces the risk of complications, but increases arrhythmia recurrence rate.

A rapid wide complex tachycardia

A rapid wide complex tachycardia

416 DESMOPLAKIN CARDIOMYOPATHY PRESENTING WITH CARDIAC ARREST IN A PATIENT WITH MYOCARDIAL NON-COMPACTION AND LEFT ACCESSORY PATHWAY

Abstract Introduction Desmoplakin is a human protein which plays a key role into desmosomes structure. Desmoplakin gene mutations can cause the so-called "desmoplakin cardiomyopathy", a form of arrhythmogenic cardiomyopathy. Its clinical history is characterized by severe ventricular arrhythmias, episodic myocardial injury and left ventricular systolic dysfunction associated with fibrosis. Case Presentation A 12-years-old male came to our inherited cardiomyopathy ambulatory for cardiological evaluation due to a previous history of cardiac arrest when he was infant (30 days newborn) and palpitation. Previous medical history included eczematous dermatitis and occasional hyperglycemia. During cardiological evaluation EKG was unremarkable, echocardiography revealed myocardial noncompaction in apical and mid-ventricular regions of the left ventricle's infero-lateral wall (end systolic ratio 2:1) and evidence of direct blood flow into deep intertrabecular recesses by colour doppler. Due to history of palpitation an EP study was performed that showed a lateral left-sided accessory pathway that was ablated during the same procedure. A genetic molecular analysis with exome sequencing (NGS, next generation sequencing) was performed and revealed a heterozygous genetic variant in DSP (Desmoplakin) gene on chromosome 6 (c.4046 G&amp;gt;A pSer1349Asn). Familiar screening revealed the same genetic variant in his father and his brother, both had no cardiological events. Conclusion Desmoplakin cardiomyopathy may have a severe clinical presentation with cardiac arrest. A multidisciplinary approach is suggested for a tailored management of these patients.

Electrophysiological characteristics of right- and left-sided Mahaim accessory pathways: A single-center experience in China.

Mahaim-type accessory pathways (MAPs) are rare accessory pathways (APs) with specific properties. They are mostly located in the right side of the heart but rarely exist on the left side. This study aims to analyze the clinical and electrophysiological (EP) characteristics of both-sided MAPs. A total of 2,249 patients with AP from our center were enrolled between 1 January 2011 and 27 March 2022. During the EP study (EPS) 17 patients were diagnosed with MAPs (right-sided: n = 13, left-sided: n = 4) according to the properties of Mahaim fibers. MAPs constitute 0.75% of all APs. Out of 1,553 patients with left-sided APs, four patients (0.26%) were diagnosed with Mahaim fiber-mediated tachycardia. Out of 696 patients with right-sided APs, 13 patients (1.9%) were diagnosed with Mahaim fiber. Most Mahaim fibers were located at the free wall of the tricuspid and mitral annuli. Seven patients of right-sided MAPs were of atriofasicular type, six patients had right-sided MAPs, and all of the patients with left-sided MAPs were of atrioventricular (AV) type. The M potential only was detected in long-length MAPs. Coexistence with other supraventricular tachycardias (SVTs) was also observed both in patients with right-sided and left-sided MAPs. All the patients underwent radiofrequency ablation successfully. Only one patient had tachycardia recurrence during a follow-up. Although MAPs are commonly located at right sides, left sites are not impossible. The M potential contributes to the improvement of the successful ablation.

Endocardial ablation at the mitral valve vestibule and its surroundings for the treatment of arrhythmias linked to the greater cardiac vasculature.

The role of the epicardial vasculature in supraventricular and ventricular arrhythmias was described in clinical studies as well as its treatment by intravascular point ablation or alcohol injection. We report on a case series of patients with different arrhythmias linked to an epicardial site of origin with evidence supporting transmural extensions that were targeted for ablation with successful outcomes. The records of patients who has catheter ablation for Supraventricular or Ventricular arrhythmias between 2015 and 2020 was searched for patients with (1) arrhythmias linked to the epicardial vasculature and (2) findings to support an endocardial connection to the epicardial vasculature by activation mapping, pace mapping, or differential pacing, and (3) were successfully ablated via an endocardial approach only. From the data searched, we identified five patients with the following arrhythmias left ventricular summit ectopy, peri-mitral atrial flutter, preexcitation with inducible atrioventricular reentry tachycardia (AVRT), and a concealed left side accessory pathway with inducible AVRT that were linked to the following vessels: Great Cardiac vein, persistent left superior vena cava, left coronary cusp, and left ventricular outflow tract. Endocardial connections were supported by a combination of electro anatomical activation mapping, pace-mapping, and differential pacing. Endocardial ablations performed in all patients were successful without complications. This report highlights a subset of patients with arrhythmias linked to the greater cardiac vascular system that can be safely and effectively ablated endocardially, given the limitations and possible complications of epicardial ablation within or in the proximity of the epicardial vasculature.

Atrial activation sequence changes during ventricular overdrive pacing: What is the mechanism?

We describe atrial activation sequence changes during ventricular overdrive pacing in a patient with a concealed left-sided accessory pathway and discuss its potential mechanism.

Transseptal versus retrograde approach for ablation of left-sided accessory pathways: impact on radiation exposure

Management of left-sided accessory pathways (APs) is based on catheter ablation through an antegrade or retrograde approach. Both are safe and effective but are associated with exposure to x-rays; however, recipients of ablation are generally young. We sought to evaluate the impact of the approach chosen on dose–area product (DAP). A total of 95 patients who underwent radiofrequency ablation of a left-sided AP between January 2011 and January 2020 were included. The primary endpoint was the radiation dose received by the patient. Secondary endpoints were procedural success and complication and recurrence rates. The mean age of the study population was 34.3 ± 16.6 years. The antegrade transseptal approach was used in 63.5% of cases. By multivariate analysis, the antegrade transseptal approach was associated with a 53% reduction in DAP (p < 0.001). The radiation dose received was also significantly associated with body mass index and total fluoroscopy time (p < 0.001). There was no significant difference in other secondary endpoints between approaches. The use of an antegrade transseptal approach is associated with a significant reduction in DAP compared with the retrograde approach, and procedural success and complication and recurrence rates are similar.

Association of T-box gene polymorphisms with the risk of Wolff-Parkinson-White syndrome in a Han Chinese population.

Abnormal development of the atrioventricular ring can lead to the formation of a bypass pathway and the occurrence of Wolff–Parkinson–White (WPW) syndrome. The genetic mechanism underlying the sporadic form of WPW syndrome remains unclear. Existing evidence suggests that both T-box transcription factor 3 (TBX3) and T-box transcription factor 2 (TBX2) genes participate in regulating annulus fibrosus formation and atrioventricular canal development. Thus, we aimed to examine whether single-nucleotide polymorphisms (SNPs) in the TBX3 and TBX2 genes confer susceptibility to WPW syndrome in a Han Chinese Population. We applied a SNaPshot SNP assay to analyze 5 selected tagSNPs of TBX3 and TBX2 in 230 patients with sporadic WPW syndrome and 231 sex- and age-matched controls. Haplotype analysis was performed using Haploview software. Allele C of TBX3 rs1061657 was associated with a higher risk of WPW syndrome (odds ratio [OR] = 1.41, 95% confidence interval [CI]: 1.08–1.83, P = .011) and left-sided accessory pathways (OR = 1.40, 95% CI: 1.07–1.84, P = .016). However, allele C of TBX3 rs8853 was likely to reduce these risks (OR = 0.71, 95% CI: 0.54–0.92, P = .011; OR = 0.70, 95% CI: 0.53–0.92, P = .011, respectively). The data revealed no association between TBX3 rs77412687, TBX3 rs2242442, or TBX2 rs75743672 and WPW syndrome. TBX3 rs1061657 and rs8853 are significantly associated with sporadic WPW syndrome among a Han Chinese population. To verify our results, larger sample sizes are required in future studies.

Fixed complex electrograms during sinus rhythm and local pacing: potential ablation targets for persistent atrial fibrillation

In atrial fibrillation (AF) patients, complex electrograms during sinus rhythm (C-EGMs) could be pathological or not. We aimed to demonstrate whether local pacing was helpful to discern pathological C-EGMs. 126 persistent AF patients and 27 patients with left-side accessory pathway (LAP) underwent left atrial mapping during sinus rhythm. If C-EGMs were detected, local pacing was performed. If the electrograms turned normal, we defined them as non-fixed C-EGMs, otherwise as fixed C-EGMs. No difference was detected in the incidence and proportion of non-fixed C-EGMs between AF patients and LAP patients (101/126 vs. 19/27, P = 0.26; 9.1 ± 6.0% vs. 7.7 ± 5.7%, P = 0.28). However, the incidence and proportion of fixed C-EGMs were higher in persistent AF patients (87/126 vs. 1/27, P < 0.01; 4.3 ± 3.4% vs. 0.1 ± 0.5%, P < 0.01). Compared with non-fixed C-EGMs, fixed C-EGMs had lower amplitudes, longer electrogram durations and longer Stimuli-P wave internals. All AF patients received circumferential pulmonary vein isolation. Among AF patients with fixed C-EGMs, 45 patients received fixed C-EGMs ablation and 42 patients underwent linear ablation. Compared with linear ablation, fixed C-EGMs ablation reduced recurrence (HR: 0.43; 95% CI 0.21‐0.81; P = 0.011). Among patients without fixed C-EGMs ablation, the proportion of fixed C-EGMs was an independent predictor of ablation outcomes (HR for per percent: 1.13, 95% CI 1.01–1.28, P = 0.038). C-EGMs could be classified into fixed and non-fixed C-EGMs through local pacing. Fixed rather than non-fixed C-EGMs might indicate abnormal atrial substrates and fixed C-EGMs ablation improve outcomes of persistent AF ablation.

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

BackgroundCatheter ablation is recommended to eradicate supraventricular tachycardia caused by left-sided accessory pathways (APs) in children. This study aims to compare the safety and efficacy of the transseptal approach (TS) and aortic approach (TA) for catheter ablation of left-sided APs in a pediatric cohort.MethodsPatients < 18 years of age with left-sided APs who had undergone ablation at Beijing Children’s Hospital between 13 January 2018 and 7 January 2020 were included and randomly categorized into either TS or TA group (follow-up for 22 months). In all, 60 patients in TS group and 41 patients in TA group were included in this study. Principal endpoints were success rate, recurrence rate, complications, procedure time, and radiation dose.ResultsFor TS group versus TA group, success rate was observed in 100 versus 97.56% (p = 0.402). The procedure time was 27.0 (32.0–23.0) versus 29.0 (38.0–24.5) min (p = 0.092). The rate of success or the procedure time was similar, but for the patients with Aps located in left posterior septum (LPS) or left posterior lateral (LPL), the TS group had a shorter procedure time compared with TA group (p < 0.01). The radiation dose was 28.0 (20.0–41.75) versus 0 mGy (p < 0.001). After successful ablation, no recurrence and complication were observed in either group.ConclusionBoth TS and TA for catheter ablation of left-sided Aps were shown to be safe and effective in children. Zero radiation and ease of mastery make TA the preferred choice. TS is recommended to be used by properly trained medical professionals, especially for patient with AP localized in the LPL or LPS. However, TS is a good alternative where patients have aortic lesions or when TA fails.