title: Transseptal access in pediatric and congenital electrophysiology procedures: defining risk.
abstract: OBJECTIVE
  Transseptal puncture (TSP) is commonly used to access the left heart for catheter ablation procedures. The specific complication risk of this procedure has not been determined. This study assesses the risk of TSP using a single standard technique during electrophysiology study (EPS) in pediatrics and congenital heart disease (CHD).
  
  
  METHODS
  Retrospective cohort study of patients undergoing TSP during EPS at the University of Michigan Congenital Heart Center between 1999 and 2011.
  
  
  RESULTS
  There were 373 left heart ablation procedures during the study period. Excluded were six adults without CHD, five procedures using an alternative imaging modality, five procedures using retrograde aortic access, one transhepatic access, and one where TSP was performed during a prior procedure. Included were 321 pediatric (≤18 years old without CHD) TSP procedures (median age 13 years) and 34 TSP procedures in patients with CHD (median age 28 years). There was one complication directly attributable to TSP: needle perforation of the left atrium without development of effusion in the pediatric group. Post-procedure echocardiograms were performed in 351 (99 %) cases, showing only trivial effusions in seven (1.9 %).
  
  
  CONCLUSIONS
  This single center experience over 12 years shows the risk of TSP in pediatric and CHD patients to be low, with a 0.3 % (95 % confidence interval (CI) 0, 0.9 %) risk for complications directly related to TSP using only single plane fluoroscopy for visualization.
authors.affiliation: University of Michigan, 1540 E. Hospital Dr, Ann Arbor, MI, 48109, USA, jvonalve@med.umich.edu.
authors.forename: Johannes C
authors.initials: JC
authors.lastname: von Alvensleben
authors.forename: Macdonald
authors.initials: M
authors.lastname: Dick
authors.forename: David J
authors.initials: DJ
authors.lastname: Bradley
authors.forename: Martin J
authors.initials: MJ
authors.lastname: LaPage
mesh_terms: D000293:Adolescent; D000328:Adult; D006328:Cardiac Catheterization / Q000706:statistics & numerical data*; D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data*; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D002648:Child; D015331:Cohort Studies; D006330:Heart Defects, Congenital; D006331:Heart Diseases; D006346:Heart Septum / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D008824:Michigan / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D011677:Punctures / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult