title: Evaluation of adult versus pediatric transesophageal echocardiography probe efficiency for guiding septal puncture during atrial fibrillation ablation.
abstract: OBJECTIVE
  Transesophageal echocardiography (TEE) has a pivotal role in invasive cardiology practice in terms of guiding a variety of procedures. It is challenging to perform TEE examination with sedated patients due to difficulties in cooperation and positioning the patient properly, therefore the risk of complications is escalated. We aimed to assess the impact of pediatric TEE probe utilization on procedural success and complication rates; in comparison with conventional adult TEE probe.
  
  
  METHODS
  Fifty-eight patients undergoing atrial fibrillation (AF) ablation with TEE guidance were enrolled and patients were grouped based on probe size: Group 1 (n = 35) included patients undergoing the procedure with adult TEE probe guidance and Group 2 (n = 23) included patients with pediatric TEE probe guidance. Procedural success, postprocedural odynophagia and periprocedural intra-oral bleeding frequency, number of intubation attempts, TEE imaging time, and midazolam doses for both groups were compared.
  
  
  RESULTS
  Odynophagia frequency was significantly higher in Group 1 (25.7% [n = 9] vs. 0%, P = 0.008) besides oral mucosal bleeding was also higher in Group 1, although the difference did not reach statistical significance (5.7% [n = 2] vs. 0%, P = 0.513). Number of repeated attempts was lower in Group 2 (median, 1; range [3-1] vs. 1, [1-1], P = 0.038). Image resolutions and septal puncture success rates were similar for both groups. Total imaging time with TEE was significantly shorter in Group 2 (6.4 ± 1.8 min vs. 3.6 ± 0.9 min, P < 0.001). Midazolam dose was lower in Group 2 (7.0 ± 1.7 vs. 6.2 ± 1.7, P = 0.065).
  
  
  CONCLUSIONS
  Using TEE probes with smaller size for guiding invasive percutaneous procedures performed in cardiac catheterization laboratory decreased TEE-associated complication rates and enhanced patient comfort without any negative effect on procedural success.
authors.affiliation: Department of Cardiology, Faculty of Medicine, Medipol University Hospital, Istanbul, Turkey.
authors.forename: Ekrem
authors.initials: E
authors.lastname: Guler
authors.affiliation: Department of Cardiology, Faculty of Medicine, Medipol University Hospital, Istanbul, Turkey.
authors.forename: Gamze
authors.initials: G
authors.lastname: Babur Guler
authors.affiliation: Department of Cardiology, Faculty of Medicine, Medipol University Hospital, Istanbul, Turkey.
authors.forename: Gultekin Gunhan
authors.initials: GG
authors.lastname: Demir
authors.affiliation: Department of Cardiology, Faculty of Medicine, Medipol University Hospital, Istanbul, Turkey.
authors.forename: Filiz
authors.initials: F
authors.lastname: Kizilirmak
authors.affiliation: Department of Cardiology, Faculty of Medicine, Medipol University Hospital, Istanbul, Turkey.
authors.forename: Hacı Murat
authors.initials: HM
authors.lastname: Gunes
authors.affiliation: Department of Cardiology, Faculty of Medicine, Medipol University Hospital, Istanbul, Turkey.
authors.forename: İrfan
authors.initials: İ
authors.lastname: Barutcu
authors.affiliation: Department of Cardiology, Faculty of Medicine, Medipol University Hospital, Istanbul, Turkey.
authors.forename: Mehmet Muhsin
authors.initials: MM
authors.lastname: Turkmen
authors.affiliation: Department of Cardiology, Faculty of Medicine, Medipol University Hospital, Istanbul, Turkey.
authors.forename: Fethi
authors.initials: F
authors.lastname: Kilicaslan
mesh_terms: D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation; D017548:Echocardiography, Transesophageal / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006346:Heart Septum / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011677:Punctures; D018084:Ultrasonography, Interventional
keywords: atrial fibrillation; catheter ablation; transesophageal echocardiography