Pediatric Cardiology

, Volume 40, Issue 4, pp 799–804 | Cite as

Transseptal Puncture for Catheter Ablation in Children

  • Serhat KocaEmail author
  • Celal Akdeniz
  • Volkan Tuzcu
Original Article


Transseptal puncture (TP) is used in pediatric patients to access the left atrium in left-sided arrhythmia catheter ablation. Performing this procedure can be difficult and risky, especially in small children. In this study, we aimed to evaluate the safety and feasibility of TPs in children ≤ 30 kg. Between April 2012 and April 2018, a retrospective evaluation was conducted of the clinical features, procedural outcomes, and follow-ups of ≤ 30 kg pediatric patients who required TPs for left-sided ablations at a pediatric electrophysiology center in which a three-dimensional mapping system was routinely used. A total of 45 pediatric patients who were ≤ 30 kg, underwent TPs: 10 patients ≤ 20 kg (Group 1) and 35 patients > 20 kg and ≤ 30 kg (Group 2). The TP success rate was 97.8%. The median procedure and fluoroscopy times were 120 min and 5.43 min, respectively. One patient developed self-limited pericardial effusion during the procedure; however, there were no incidences of cardiac tamponade. There was no significant difference between the two groups in terms of the procedure time and fluoroscopy time, and pericardial effusion was only observed in Group 2. TPs are safe and feasible in small children. These procedures can be performed with low complication rates in children weighing ≤ 30 kg.


Transseptal puncture Small children Catheter ablation 




Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from the children’s parents/guardians.

Research Involving with Human and Animal Participants

This article does not contain any studies with animals performed by any of the authors.


  1. 1.
    Brugada J, Blom N, Sarquella-Brugada G, Blomstrom-Lundqvist C, Deanfield J, Janousek J, Abrams D et al (2013) European Heart Rhythm Association; Association for European Paediatric and Congenital Cardiology. Pharmacological and non-pharmacological therapy for arrhythmias in the pediatric population: EHRA and AEPC-Arrhythmia Working Group joint consensus statement. Europace 15:1337–1382CrossRefPubMedGoogle Scholar
  2. 2.
    Kubus P, Vıt P, Gebauer RA, Zaoral L, Peichl P, Fiala M, Janoušek J (2014) Long-term results of paediatric radiofrequency catheter ablation: a population-based study. Europace 16:1808–1813CrossRefPubMedGoogle Scholar
  3. 3.
    Hiippala A, Happonen JM (2015) Population-based single-center outcome for pediatric catheter ablation of common supraventricular tachycardias. Pacing Clin Electrophysiol 38:115–119CrossRefPubMedGoogle Scholar
  4. 4.
    Anselmino M, Matta M, Saglietto A, Calò L, Giustetto C, Scaglione M, Gaita F (2018) Transseptal or retrograde approach for transcatheter ablation of left sided accessory pathways: a systematic review and meta-analysis. Int J Cardiol 272:202–207CrossRefPubMedGoogle Scholar
  5. 5.
    Roelke M, Smith AJ, Palacios IF (1994) The technique and safety of transseptal left heart catheterization: the Massachusetts General Hospital experience with 1,279 procedures. Cathet Cardiovasc Diagn 32:332–339CrossRefPubMedGoogle Scholar
  6. 6.
    De Ponti R, Cappato R, Curnis A, Della Bella P, Padeletti L, Raviele A, Santini M et al (2006) Trans-septal catheterization in the electrophysiology laboratory: data from a multicenter survey spanning 12 years. J Am Coll Cardiol 47:1037–1042CrossRefPubMedGoogle Scholar
  7. 7.
    Bowers MR, O’Neill PG, Bhaskar R, Aryana A (2018) Three-dimensional electroanatomical mapping to guide transseptal catheterization HeartRhythm. Case Rep 6:219–221Google Scholar
  8. 8.
    An HS, Choi EY, Kwon BS, Kim GB, Bae EJ, Noh CI, Choi JY (2013) Radiofrequency catheter ablation for supraventricular tachycardia: a comparison study of children aged 0–4 and 5–9 years. Pacing Clin Electrophysiol 36:1488–1494CrossRefPubMedGoogle Scholar
  9. 9.
    Backhoff D, Klehs S, Müller MJ, Schneider H, Kriebel T, Paul T, Krause U (2016) Radiofrequency catheter ablation of accessory atrioventricular pathways in infants and toddlers ≤ 15 kg. Pediatr Cardiol 37:892–898CrossRefPubMedGoogle Scholar
  10. 10.
    Friedman RA, Walsh EP, Silka MJ, Calkins H, Stevenson WG, Rhodes LA, Deal BJ et al (2002) NASPE Expert Consensus Conference: radiofrequency catheter ablation in children with and without congenital heart disease. Report of the writing committee. North American Society of Pacing and Electrophysiology. Pacing Clin Electrophysiol 25:1000–1017Google Scholar
  11. 11.
    von Alvensleben JC, Dick M II, Bradley DJ, LaPage MJ (2014) Transseptal access in pediatric and congenital electrophysiology procedures: defining risk. J Interv Card Electrophysiol 41:273–277CrossRefGoogle Scholar
  12. 12.
    Lesh MD, Van Hare GF, Scheinman MM, Ports TA, Epstein LA (1993) Comparison of the retrograde and transseptal methods for ablation of left free wall accessory pathways. J Am Coll Cardiol 22:542–549CrossRefPubMedGoogle Scholar
  13. 13.
    Calkins H, Langberg J, Sousa J, el-Atassi R, Leon A, Kou W, Kalbfleisch S et al (1992) Radiofrequency catheter ablation of accessory atrioventricular connections in 250 patients: abbreviated therapeutic approach to Wolff-Parkinson-White. Circulation 85:1337–1346CrossRefPubMedGoogle Scholar
  14. 14.
    Hashem S, Choudhury AK, Paul GK, Rahman MZ (2015) Comparison between retrograde and transeptal approach in radiofrequency catheter ablation of left accessory pathways. Mymensingh Med J 24:94–102PubMedGoogle Scholar
  15. 15.
    Law IH, Fischbach PS, LeRoy S, Lloyd TR, Rocchini AP, Dick M (2001) Access to the left atrium for delivery of radiofrequency ablation in young patients: retrograde aortic vs transseptal approach. Pediatr Cardiol 22:204–209CrossRefPubMedGoogle Scholar
  16. 16.
    Bashore TM, Bates ER, Berger PB, Clark DA, Cusma JT, Dehmer GJ, Kern MJ et al (2011) American College of Cardiology. Task Force on Clinical Expert Consensus Documents. American College of Cardiology/Society for Cardiac Angiography and Interventions Clinical Expert Consensus Document on cardiac catheterization laboratory standards. A report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol 37:2170–2214CrossRefGoogle Scholar
  17. 17.
    Venneri L, Rossi F, Botto N, Andreassi MG, Salcone N, Emad A, Lazzeri M et al (2009) Cancer risk from professional exposure in staff working in cardiac catheterization laboratory: insights from the National Research Council’s Biological Effects of Ionizing Radiation VII Report. Am Heart J 157:118–124CrossRefPubMedGoogle Scholar
  18. 18.
    Efstathopoulos EP, Katritsis DG, Kottou S, Kalivas N, Tzanalaridou E, Giazitzoglou E, Korovesis S et al (2006) Patient and staff radiation dosimetry during cardiac electrophysiology studies and catheter ablation procedures: a comprehensive analysis. Europace 8:443–448CrossRefPubMedGoogle Scholar
  19. 19.
    Yoshida S, Suzuki T, Yoshida Y, Watanabe S, Nakamura K, Sasaki T, Kawasaki Y et al (2016) Feasibility and safety of transseptal puncture procedures for radiofrequency catheter ablation in small children weighing below 30 kg: single-centre experience. Europace 18:1581–1586CrossRefPubMedGoogle Scholar
  20. 20.
    McCauley MD, Patel N, Greenberg SJ, Molina-Razavi JE, Safavi-Naeini P, Razavi M (2016) Fluoroscopy-free atrial transseptal puncture. Eur J Arrhythm Electrophysiol 2:57CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Clark J, Bockoven JR, Lane J, Patel CR, Smith G (2008) Use of three-dimensional catheter guidance and trans-esophageal echocardiography to eliminate fluoroscopy in catheter ablation of left-sided accessory pathways. Pacing Clin Electrophysiol 31:283–289CrossRefPubMedGoogle Scholar
  22. 22.
    Gaita F, Caponi D, Pianelli M, Scaglione M, Toso E, Cesarani F, Boffano C et al (2010) Radiofrequency catheter ablation of atrial fibrillation: a cause of silent thromboembolism? Magnetic resonance imaging assessment of cerebral thromboembolism in patients undergoing ablation of atrial fibrillation. Circulation 122:1667–1673CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Pediatric Cardiology/ElectrophysiologyIstanbul Medipol University HospitalIstanbulTurkey
  2. 2.Yuksek Ihtisas HospitalAnkaraTurkey

Personalised recommendations