Surgical electrocautery facilitated transseptal puncture in children
Claude Samy Elayi1, John Carl Gurley, Thomas Gerald Di Sessa
1Gill Heart Institute, University of Lexington, Lexington, Kentucky, USA.
Insights
Radiofrequency (RF) energy facilitates transseptal puncture in pediatric patients, proving safe and routine for electrophysiology procedures. This technique simplifies crossing the elastic septum in children, enabling effective treatment for supraventricular tachycardia.
Area of Science:
- Pediatric Cardiology
- Electrophysiology
- Medical Device Technology
Background:
- Transseptal puncture is a critical procedure in pediatric electrophysiology.
- Pediatric patients present unique challenges due to elastic septa and smaller atria.
- Radiofrequency (RF) energy is routinely used in adults to facilitate transseptal puncture.
Purpose of the Study:
- To evaluate the routine use of RF energy for transseptal puncture in pediatric patients.
- To determine the safety and efficacy of RF-assisted transseptal procedures in children.
Main Methods:
- A prospective study of 13 pediatric patients undergoing ablation requiring transseptal puncture.
- Utilized standard surgical electrocautery (30W, cut mode) applied to the transseptal needle.
- Procedures performed under general anesthesia with post-procedure complication monitoring.
Main Results:
- RF-assisted transseptal puncture was successful in all 13 pediatric patients.
- A single RF application (30W, <2 seconds) sufficed in most cases; two patients required adjustments.
- No acute or follow-up complications were observed, demonstrating a safe profile.
Conclusions:
- Transseptal puncture facilitated by RF energy is a safe and routine option for pediatric electrophysiology.
- This technique effectively overcomes challenges associated with pediatric cardiac anatomy.
- RF energy offers a reliable method for pediatric transseptal access during ablation procedures.
Background:
Transseptal puncture has been performed in adults and children for decades. However, transseptal puncture can be challenging especially in pediatric patients because of an elastic septum and small atria. In adults, dedicated radiofrequency (RF) to facilitate transseptal puncture has become routine.
Objectives:
We wanted to assess whether RF could be used routinely in children to facilitate transseptal procedure.
Method:
The study population included all children referred to our electrophysiology lab who underwent an ablation requiring a transseptal puncture over a period of 10 months. RF was applied at the time of transseptal puncture. The source of RF was standard surgical electrocautery device with the electrosurgical pen in direct contact with the transseptal needle applied for a short period of time during transseptal puncture. RF output was set initially at 30 W in cut mode. All procedures were performed under general anesthesia. Patients were followed for possible complications.
Results:
Thirteen patients (ages 11.6 ± 3.6 years, range 5-17 years, five boys) were included. One patient had left ventricular tachycardia, and the remainder had a supraventricular tachycardia with a left-sided accessory pathway. In all but two patients, a single attempt with an RF output of 30 W applied for less than 2 seconds was sufficient to cross the septum. In two patients, three attempts were needed with a last successful attempt using 35 W. No complications were observed either acutely or during the follow-up.
Conclusion:
Transseptal puncture facilitated by RF energy can be performed in children routinely and safely.
