Thorac Cardiovasc Surg 2014; 62 - p45
DOI: 10.1055/s-0034-1394068

Transseptal Puncture for Radiofrequency Ablations in a Pediatric Population

D. Ehrlinspiel 1, C. Balmer 1, V. Kühlkamp 2, M. Gass 1, 2
  • 1Childrens Hospital Zurich, Switzerland
  • 2HZB Constance, Germany

Introduction: In adults, transseptal puncture (TSP) for radiofrequency catheter ablations (RFA) is a frequent procedure with a low rate of complications. In children, literature on this topic is rare. The conditions are different due to smaller size of the vessels and the atria, suggesting a technically more challenging procedure. The aim was to describe the practicability and safety of the procedure of TSP in a pediatric cohort.

Method: Retrospective analysis of all consecutive patients below 18 years of age with attempted TSP for electrophysiology studies in two centers from 2005 through 2013. All procedures were performed under general anesthesia. The TSP was performed using a Brockenbrough needle in a Mullins sheath under biplane fluoroscopic guidance. At the end of the procedure, absence of a pericardial effusion was confirmed in all patients by echocardiography.

Results: The study cohort consisted of 157 patients with a median age of 12.5 years (range 1.1 - 17.9) and a median weight of 42 kg (range 9.0 - 97.0) with the following diagnoses: Left sided accessory pathway (WPW 91%, PJRT 2%), ectopic atrial focus 6%, and atypical AVNRT 1.3%. 3 patients had a congenital heart defect. The size of the sheath ranged from 6 - 8.5 F (6F in 15%, 7F in 16%, 8F in 67%, and 8.5F in 2%). Successful TSP was possible in 99.4%. Except one patient in whom the atrial septum was very floppy and therefore the left atrium to small. In 3 patients, additional TEE was necessary. 98.1% of patients underwent successful radiofrequency ablation. Median procedure time was 120 min (range 60 to 450) with radioscopy duration of median 10.5 min (range 1.8 to 75). There were no complications, i.e. no pericardial effusion, no puncture of the aortic root, no stroke or ischemic event, and no death.

Conclusions: In children and adolescents, TSP is a feasible and safe procedure. It creates a direct access to the left atrium allowing radiofrequency ablation with a high success rate.