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Transseptal puncture during catheter ablation associated with higher radiation exposure

Published online by Cambridge University Press:  08 June 2022

Maryam Rahman Open the ORCID record for Maryam Rahman [Opens in a new window] ,
Grace Smith ,
Chris Johnsrude ,
Martin LaPage ,
Jeremy Moore ,
Kevin Shannon ,
Chris Anderson ,
John Papagiannis ,
Kelvin Lau  and
Shubhayan Sanatani
...Show all authors
Maryam Rahman*
Affiliation:
The Heart Center, Akron Children’s Hospital, Akron, OH, USA
Grace Smith
Affiliation:
The Heart Center, Akron Children’s Hospital, Akron, OH, USA
Chris Johnsrude
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Norton Children’s Heart Institute, Louisville, KY, USA
Martin LaPage
Affiliation:
Division of Pediatric Cardiology, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI, USA
Jeremy Moore
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, UCLA Mattel Children’s Hospital, Los Angeles, CA, USA
Kevin Shannon
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, UCLA Mattel Children’s Hospital, Los Angeles, CA, USA
Chris Anderson
Affiliation:
Center for Congenital Heart Disease, Providence Sacred Heart Children’s Hospital, Spokane, WA, USA
John Papagiannis
Affiliation:
Division of Cardiology, Children’s Mercy Hospital, Kansas City, MO, USA
Kelvin Lau
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Norton Children’s Heart Institute, Louisville, KY, USA
Shubhayan Sanatani
Affiliation:
Division of Cardiology, Department of Pediatrics, British Columbia Children’s Hospital, Vancouver, BC, Canada
Mansour Razminia
Affiliation:
Clinical Cardiac Electrophysiology, Amita Health Saint Joseph Hospital, Elgin, IL, USA
Volkan Tuzcu
Affiliation:
Department of Pediatric Cardiology/Electrophysiology, Istanbul Medipol University Hospital, Istanbul, Turkey
David Gothard
Affiliation:
Biostats, Inc., East Canton, OH, USA
Lisa Shauver
Affiliation:
Rebecca D. Considine Research Institute, Akron Children’s Hospital, Akron, OH, USA
John Clark
Affiliation:
The Heart Center, Akron Children’s Hospital, Akron, OH, USA
*
Author for correspondence: Maryam Rahman, DO, Department of Cardiology, Akron Children’s Hospital, The Heart Center, One Perkins Square, Akron, OH 44308, USA. Tel: 330-543-8521; Fax: 330-543-8208; E-mail: mrahman@akronchildrens.org
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Abstract

Background:

Electroanatomic mapping systems are increasingly used during ablations to decrease the need for fluoroscopy and therefore radiation exposure. For left-sided arrhythmias, transseptal puncture is a common procedure performed to gain access to the left side of the heart. We aimed to demonstrate the radiation exposure associated with transseptal puncture.

Methods:

Data were retrospectively collected from the Catheter Ablation with Reduction or Elimination of Fluoroscopy registry. Patients with left-sided accessory pathway-mediated tachycardia, with a structurally normal heart, who had a transseptal puncture, and were under 22 years of age were included. Those with previous ablations, concurrent diagnostic or interventional catheterisation, and missing data for fluoroscopy use or procedural outcomes were excluded. Patients with a patent foramen ovale who did not have a transseptal puncture were selected as the control group using the same criteria. Procedural outcomes were compared between the two groups.

Results:

There were 284 patients in the transseptal puncture group and 70 in the patent foramen ovale group. The transseptal puncture group had a significantly higher mean procedure time (158.8 versus 131.4 minutes, p = 0.002), rate of fluoroscopy use (38% versus 7%, p < 0.001), and mean fluoroscopy time (2.4 versus 0.6 minutes, p < 0.001). The acute success and complication rates were similar.

Conclusions:

Performing transseptal puncture remains a common reason to utilise fluoroscopy in the era of non-fluoroscopic ablation. Better tools are needed to make non-fluoroscopic transseptal puncture more feasible.

Keywords

Transseptal punctureablationradiationfluoroscopy3D mappingarrhythmia
Type
Original Article
Information
Cardiology in the Young , Volume 33 , Issue 5 , May 2023 , pp. 754 - 759
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Copyright
© The Author(s), 2022. Published by Cambridge University Press

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