The Trans-Axillary Vein Approach for the Ablation of Anterior–Septal, Anterior, and Anterior–Lateral Accessory Pathways in Children: More than an Alternative to the Femoral Vein

TL;DR

This study compares the trans-axillary vein approach to the femoral vein approach for ablation of accessory pathways in children, finding the former to be safe and effective.

Contribution

The study introduces the trans-axillary vein approach as a novel alternative to the femoral approach for pediatric ablation procedures.

Findings

The trans-axillary approach had a significantly lower recurrence rate (4.5%) compared to the femoral approach (27.2%) at 1-year follow-up.

No acute or follow-up complications occurred in either group.

Acute success rates were similar between the two groups.

Abstract

Background: Catheter ablation of right anterior, anterior–lateral, and anterior–septal accessory pathways is still challenging in children, even after seminal improvements in mapping and catheter design over the last years. The trans-jugular approach was described as an alternative to the femoral vein recently. As a direct comparison between the femoral approach and the superior approach using the axillary vein was lacking, we conducted the present study. Methods: Twenty-two pediatric patients were enrolled in this retrospective study. Patients with prior ablation attempts were excluded. Another 22 consecutive patients with the same AP localizations were selected as a control group and treated with ablation through the femoral vein. Left axillary vein cannulation was performed advancing an 18-gauge needle using fluoroscopic landmarks (the first rib below the inferior border of the clavicle). All mapping and ablations of accessory pathways were performed with a 7 F deflectable radiofrequency ablation catheter. The main outcome of this study was ablation success at 1 year. Recurrences were defined as a relapse of preexcitation on a 12-lead electrocardiogram and/or documented supraventricular tachycardia. Results: There were no significant differences in sex, age, or weight between groups. No complications occurred acutely or during follow-up. There were no significant differences in acute success rates between the two groups (19/22 vs. 22/22; p = 0.56) at 24 h ECG recordings. At the 1-year follow-up the total recurrence rate was 15.9% (7/44 patients); there was a significantly lower recurrence rate among patients in the trans-jugular group (27.2% vs. 4.5%; p = 0.039). Conclusions: The present study suggests that the trans-axillary vein approach is a safe and effective alternative to the classical femoral approach in pediatric patients.

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