title: Surgical electrocautery facilitated transseptal puncture in children.
abstract: 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.
  
  
  OBJECTIVE
  We wanted to assess whether RF could be used routinely in children to facilitate transseptal procedure.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Transseptal puncture facilitated by RF energy can be performed in children routinely and safely.
authors.affiliation: Gill Heart Institute, University of Lexington, Lexington, Kentucky, USA.
authors.forename: Claude Samy
authors.initials: CS
authors.lastname: Elayi
authors.forename: John Carl
authors.initials: JC
authors.lastname: Gurley
authors.forename: Thomas Gerald
authors.initials: TG
authors.lastname: Di Sessa
authors.forename: Bahram
authors.initials: B
authors.lastname: Kakavand
mesh_terms: D000293:Adolescent; D017115:Catheter Ablation; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D011677:Punctures / Q000379:methods*; D012189:Retrospective Studies; D013617:Tachycardia, Supraventricular / Q000601:surgery*; D017180:Tachycardia, Ventricular / Q000601:surgery*