Transseptal access in pediatric and congenital electrophysiology procedures: defining risk

Alvensleben, Johannes C. von; Dick, Macdonald; Bradley, David J.; LaPage, Martin J.

doi:10.1007/s10840-014-9946-3

Cited by 15 publications

(17 citation statements)

References 15 publications

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“…Young age and low body weight are reported to be independent risk factors for complications during RFCA of Aps . Trans‐septal puncture (TSP) is commonly used for ablation of left‐sided Aps . However, in small children, TSP may be challenging because of the narrow access vessels and small left atria.…”

Section: Introductionmentioning

confidence: 99%

“…[3][4][5] Trans-septal puncture (TSP) is commonly used for ablation of left-sided Aps. [6][7][8] However, in small children, TSP may be challenging because of the narrow access vessels and small left atria. The aim of this study was to assess the efficacy and safety of trans-septal approach RFCA of left-sided APs in children weighing up to 30 kg.…”

Section: Introductionmentioning

confidence: 99%

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Catheter ablation of left‐sided accessory pathways in small children

Fogelman

Birk

Dagan

et al. 2019

Journal of Arrhythmia

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Background Accessory pathways (APs) are a common reason for supraventricular tachycardia in small children. Trans‐septal puncture (TSP) approach is commonly used for the ablation of left‐sided APs, however it may be challenging in small children. The aim of this study was to assess the efficacy and safety of trans‐septal approach radiofrequency (RF) ablation of left‐sided APs in children weighing up to 30 kg. Methods Of the 658 children who underwent catheter ablation of APs since 06/2002, 86 children had left‐sided AP and weighed less than 30 kg. TSP approach guided with TEE and fluoroscopy was used for left atrium access. Results The mean age, height, and body weight were 7.6 ± 1.9 years, 122.4 ± 9.3 cm and 24.0 ± 4.2 kg, respectively. Forty‐three children (50%) were male, 46 of 86 (53%) had manifest AP, 17 of 86 (20%) weighed less than 20 kg and in 24 of 86 children (28%) a three‐dimensional system (3DS) was used to reduce fluoroscopy time. The acute success rate was 98.8% (85/86), with a recurrence rate of 2.4% (2/85) in 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 group compared to the standard fluoroscopy group 131 ± 41 (55‐262) and 2.4 ± 1.5 (1‐6) minutes vs 164 ± 51 (62‐249) and 27 ± 13 (8‐77) minutes, P < 0.01 and P < 0.0001, 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.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Catheter ablation of left‐sided accessory pathways in small children

Fogelman

Birk

Dagan

et al. 2019

Journal of Arrhythmia

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“…Table 4 presents a review of the total number of TSP performed between 2008 and April of 2015. Several studies use heterogeneous populations, which includes: children's [15][16][17], abnormal atria anatomy [10,[18][19][20][21][22][23][24][25][26] and patients with previous TSP [7,8,[27][28][29][30][31][32]. The number of puncture attempts, failures and complications were registered.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Approximately 12% of the procedures required more than one puncture attempt, which increases the procedural time and the radiation exposure [6, 16, 18-22, 27, 63]. This last result indicates that FO recognition/puncture is not straightforward, claiming for novel guidance strategies and smart surgical equipment's [15,68,70].…”

Section: Incidence Studymentioning

confidence: 99%

Novel Solutions Applied in Transseptal Puncture: A Systematic Review

Morais

Vilaça²,

Ector

et al. 2017

Journal of Medical Devices

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Access to the left atrium is required for several minimally invasive cardiac interventions in the left heart. For this purpose, transseptal puncture (TSP) technique is often performed, perforating the atrial septum under fluoroscopic or/and ultrasound imaging guidance. Although this approach has been used for many years, complications/failures are not uncommon mainly in patients with abnormal atrial anatomy and repeated TSP. Thus, this study presents an overview of methods and techniques that have been proposed to increase the safety and feasibility of the TSP. A systematic review of literature was conducted through the analysis of the articles published between 2008 and 2015. The search was performed in PubMed, Scopus, and ISI Web of Knowledge using the expression “transseptal puncture.” A total of 354 articles were retrieved from the databases, and 64 articles were selected for this review. Moreover, these 64 articles were divided into four categories, namely: (1) incidence studies, (2) intraprocedural guidance techniques, (3) preprocedural planning methods, and (4) surgical instruments. A total of 36 articles focused on incidence studies, 24 articles suggested novel intraprocedural guidance techniques, 5 works focused on preprocedural planning strategies, and 21 works proposed surgical instruments. The novel 3D guidance techniques, radio-frequency surgical instruments, and pre-interventional planning approaches showed potential to overcome the main procedural limitations/complications, through the reduction of the intervention time, radiation, number of failures, and complications.

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“…Over time, additional imaging techniques, including transesophageal echocardiogram (TEE) and intracardiac echocardiography (ICE), have been used in concert with fluoroscopy in order to decrease radiation exposure and minimize risk of the procedure. While the reported incidence of complications related to TS puncture has been as low as 0.3%, there is still a substantial risk of significant morbidity and mortality. The risks of TS puncture include injury to venous structures, atrial perforation, aortic perforation, and pericardial effusion.…”

Section: Introductionmentioning

confidence: 99%