Transseptal Puncture Guided by Transesophageal Echocardiography without Fluoroscopy during Catheter Ablation of Left-Sided Accessory Pathways in Children

Background: Transseptal puncture (TSP) is a routine procedure to access the left atrium for catheter ablation of left-sided arrhythmia. However, it is still challenging in children due to not only small body, more septal flexibility and unsuitable equipment but also the long-term carcinogenic effect of X-ray. The aim of this study was to present the efficacy and safety of transseptal puncture with the help of a transesophageal echocardiography (TEE) and 3D electro-anatomical mapping systems (3D-EAM) without X-ray during the catheter ablation of left-sided accessory pathways (APs) in children.

Method: A total of 63 consecutive children with left-sided accessory pathway catheter ablation between July 2016 and September 2022 were analyzed retrospectively.

Results: A total of 50/63 (79.3%) patients were underwent TSP for left-sided catheter ablation by using transseptal needle with the help of fluoroscopy, TEE and 3D-EAM. Mean age, weight and BMI were 11.1 ± 4.1 years (range: 3–19), 47.7 ± 20.3 kg (range: 15–88) and 20.3 ± 4.5 (range: 11.8–27.5), respectively. 32/50 (64%) patients were male. 28/50 (56%) patients had manifest left-sided accessory pathways. Mean total procedure time of catheter ablation was 182.4 ± 57.0 min (range: 75–323). Mean follow-up was 34.6 ± 36.0 months (range: 2–68). Transseptal access to left atrium was performed successfully in all 50 patients. 28/50 (56%) patients were underwent TSP with zero fluoroscopy and limited fluoroscopy was used in 22/50 (36%) patients. The mean follow-up was 34.6 months (2–68) months. No complication occurred. Comparison of 28 patients with no fluoroscopy to the 22 patients with TSP via fluoroscopy showed no statistically difference in terms of acute success rate, recurrence rate and complication (p > 0.05). The mean procedure time (161.0 ± 52.3 vs. 209.7 ± 51.70) and follow-up (28.5 ± 21.8 vs. 42.3 ± 44.0 months) were significantly lower in the group of patients with no fluoroscopy (p = 0.006 and p = 0.02, respectively).

Conclusion: Transseptal approach to access in the left cardiac chambers by using TEE and 3D-EAM without fluoroscopy seems to be as safe and effective in the children.

Publication History

Article published online:
28 January 2023