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Transseptal puncture for radiofrequency catheter ablations of left-sided arrhythmias in a paediatric population

Published online by Cambridge University Press:  18 April 2016

Désirée M. Ehrlinspiel ,
Matthias Gass  and
Christian Balmer
Désirée M. Ehrlinspiel
Affiliation:
Department of Paediatric Cardiology, University Children’s Hospital Zurich, Zürich, Switzerland
Matthias Gass
Affiliation:
Department of Paediatric Cardiology, University Children’s Hospital Zurich, Zürich, Switzerland Department of Electrophysiology, Lake Constance Heart Centre, Konstanz, Germany
Christian Balmer*
Affiliation:
Department of Paediatric Cardiology, University Children’s Hospital Zurich, Zürich, Switzerland
*
Correspondence to: C. Balmer, MD, Department of Paediatric Cardiology, University Children’s Hospital, Steinwiesstrasse 75, 8032 Zürich, Switzerland. Tel: +41 44 266 73 79; Fax: +41 44 266 75 81; E-mail: [email protected]
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Abstract

Puncturing the atrial septum is frequently used in adults. In children, the transseptal puncture is less common, technically more demanding, and the rate of complications is not well described. We studied the feasibility and safety of this procedure in a retrospective analysis of 157 consecutive children undergoing transseptal puncture for radiofrequency catheter ablation of left atrial targets in two tertiary-care centres between 2005 and 2013. The median age of the patients at intervention was 12.5 years (1.1–18 years), with median weight of 42 kg (range 9.0–97.0 kg). Pre-excitation was found in 102 procedures, accessory pathway with exclusively retrograde conduction in 41, focal atrial tachycardia in nine, left-sided permanent junctional/reciprocating tachycardia-like accessory pathways in three, and atypical atrioventricular nodal re-entry tachycardia in two. All the procedures were guided by fluoroscopy. Additional imaging by transoesophageal echocardiography was used in three patients. Successful transseptal puncture was possible in 99.4% of the cases, ablation in 97.4%. The median time, including mapping and radiofrequency ablation, was 120 minutes (range 60–450), the median fluoroscopy time 10.8 minutes (range 1.8–75), and the median radiation dose 3 Gy cm2 (range 0.3–35). In total, five patients (3.2%) had a recurrent arrhythmia during the observation period of a median of 40 months (range 1–103). No complications associated with the transseptal puncture were observed. Transseptal puncture is a feasible and safe procedure in children. This access allows successful and efficient radiofrequency ablation of arrhythmia of the left atrium in the vast majority of the patients and might be considered as the first-line approach in this population.

Keywords

Transseptal punctureradiofrequency ablationarrhythmiasupraventricular tachycardiacomplications
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 2 , March 2017 , pp. 267 - 272
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Copyright
© Cambridge University Press 2016 

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References

1. Abrams, DJ. Invasive electrophysiology in paediatric and congenital heart disease. Heart 2007; 93: 383–391.Google Scholar
2. Kugler, JD, Danford, DA, Houston, KA, et al. Pediatric radiofrequency catheter ablation registry success, fluoroscopy time, and complication rate for supraventricular tachycardia: comparison early and late eras. J Cardiovasc Electrophysiol 2002; 13: 336–341.Google Scholar
3. Van Hare, GF, Javitz, H, Carmelli, D, et al. Prospective assessment after pediatric cardiac ablation: demographics, medical profiles and initial outcomes. J Cardiovasc Electrophysiol 2004; 15: 759–770.Google Scholar
4. Nielsen, JC, Kottkamp, H, Piorkowski, C, et al. Radiofrequency ablation in children and adolescents: results in 154 consecutive patients. Europace 2006; 8: 323–329.CrossRefGoogle ScholarPubMed
5. Kubus, P, Vıt, P, Gebauer, RA, et al. Long-term results of paediatric radiofrequency catheter ablation: a population-based study. Europace 2014; 16: 1808–1813.Google Scholar
6. Blaufox, AD. Catheter ablation of tachyarrhythmias in small children (review). Indian Pacing Electrophysiol J 2005; 5: 51–62.Google Scholar
7. Hiippala, A, Happonen, JM. Population-based single-center outcome for pediatric catheter ablation of common supraventricular tachycardias. Pacing Clin Electrophysiol 2015; 38: 115–119.Google Scholar
8. De Ponti, R, Zardini, M, Storti, C, et al. Trans-septal catheterization for radiofrequency catheter ablation of cardiac arrhythmias. Eur Heart J 1998; 19: 943–950.Google Scholar
9. De Ponti, R, Cappato, R, Curnis, A, et al. Trans-septal catheterization in the electrophysiology laboratory: data from a multicenter survey spanning 12 years. J Am Coll Cardiol 2006; 47: 1037–1042.Google Scholar
10. McGinty, PM, Smith, TW, Rogers, JH. Trans-septal left heart catheterization and the incidence of persistent iatrogenic atrial septal defects. J Interv Cardiol 2011; 24: 254–263.Google Scholar
11. Wong, KT, Yung, TC, Lun, KS, et al. Ten-year experience of radiofrequency catheter ablation of accessory pathways in children and young adult. HK J Paediatr (New Series) 2005; 10: 257–264.Google Scholar
12. Lenarczyk, R, Kowalski, O, Pruszkowska-Skrzep, P, et al. Radiofrequency catheter ablation in the treatment of arrhythmias in children – efficacy, safety of the method, predictors of the procedural course an acute success. Przegl Lek 2009; 66: 418–423.Google ScholarPubMed
13. Mah, DY, Miyake, CY, Sherwin, ED, et al. The use of an integrated electroanatomic mapping system and intracardiac echocardiography to reduce radiation exposure in children and young adults undergoing ablation of supraventricular tachycardia. Europace 2014; 16: 277–283.CrossRefGoogle Scholar
14. Saul, JP, Hulse, JE, De, W, et al. Catheter ablation of accessory atrioventricular pathways in young patients: use of long vascular sheaths, the transseptal approach and a retrograde left posterior parallel approach. J Am Coll Cardiol 1993; 21: 571–583.CrossRefGoogle Scholar
15. Lesh, MD, van Hare, GF, Scheinman, MM, et al. Comparison of the retrograde and transseptal methods for ablation of left free wall accessory pathways. J Am Coll Cardiol 1993; 22: 542–549.Google Scholar
16. Law, IH, Fischbach, PS, LeRoy, S, et al. Access to the left atrium for delivery of radiofrequency ablation in young patients: retrograde aortic vs transseptal approach. Pediatr Cardiol 2001; 22: 204–209.Google Scholar
17. Friedman, RA, Walsh, EP, Silka, MJ, et al. NASPE Expert Consensus Conference: radiofrequency catheter ablation in children with and without congenital heart disease. Report of the writing committee. Pacing Clin Electrophysiol 2002; 25: 1000–1017.CrossRefGoogle ScholarPubMed
18. Silva, MA, Nadalin, E, Kraemmer, A, et al. Radiofrequency catheter ablation of left accessory pathways by transseptal approach. Arquivos Brasileiros de Cardiologia 2006; 86: 331–336.Google Scholar
19. Vora, AM, McMahon, S, Jazayeri, MR, et al. Ablation of atrial insertion sites of left-sided accessory pathways in children: efficacy and safety of transseptal versus transaortic approach. Pediatr Cardiol 1997; 18: 332–338.CrossRefGoogle ScholarPubMed
20. Yoshida, S, Tsugutoshi, S, Yoshida, Y, et al. Feasibility and safety of transseptal puncture procedures for radiofrequency catheter ablation in small children weighing below 30 kg: single-centre experience. Europace. 2015 Dec 24. pii: euv383 [Epub ahead of print].Google Scholar
21. Roelke, M, Smith, AJ, Palacios, IF. The technique and safety of transseptal left heart catheterization: the Massachusetts General Hospital experience with 1279 procedures. Cathet Cardiovasc Diagn 1994; 32: 332–339.CrossRefGoogle Scholar
22. Hernández-Madrid, A, Hocini, M, Chen, J, et al. How are arrhythmias managed in the paediatric population in Europe? Results of the European Heart Rhythm Survey. Europace 2014; 16: 1852–1856.CrossRefGoogle ScholarPubMed
23. Calkins, H, Langberg, J, Sousa, J, et al. Radiofrequency catheter ablation of accessory atrioventricular connections in 250 patients – abbreviated therapeutic approach to Wolff-Parkinson-White. Circulation 1992; 85: 1337–1346.Google Scholar
24. Seifert, MJ, Morady, F, Calkins, HG, et al. Aortic leaflet perforation during radiofrequency ablation. Pacing Clin Electrophysiol 1991; 14 (Pt 1): 1582–1585.Google Scholar
25. Hashem, S, Choudhury, AK, Paul, GK, et al. Comparison between retrograde and transeptal approach in radiofrequency catheter ablation of left accessory pathways. Mymensingh Med J 2015; 24: 94–102.Google Scholar
26. Yoshida, K, Yoshikawa, J, Akasaka, T, et al. Assessment of left-to-right atrial shunting after percutaneous mitral valvuloplasty by transoesophageal color Doppler flow-mapping. Circulation 1989; 80: 1521–1526.Google Scholar
27. Fagundes, RL, Mantica, M, De Luca, L, et al. Safety of single trans-septal puncture for ablation of atrial fibrillation: retrospective study from a large cohort of patients. J Cardiovasc Electrophysiol 2007; 18: 1277–1281.Google Scholar