Heart 1998;79:379-382 ( April )
The transseptal approach for ablation of cardiac arrhythmias: experience of 104 procedures
Manchester
Heart Centre, The Royal Infirmary, Oxford Road, Manchester M13
9WL, UK
Correspondence to: Dr Fitzpatrick. email: adam.fitzpatrick{at}man.ac.uk
Accepted for publication 12 December 1997
Objective
To report retrospectively on the
training and subsequent experience of two operators in transseptal
ablation of arrhythmias arising in the left atrium and left
atrioventricular annulus, to show whether, with adequate training and
careful attention to detail, this is a safe and effective technique.
SettingElectrophysiological studies and
transseptal procedures were performed in the electrophysiology
laboratories of the Moffatt Hospital, University of California at San
Francisco (39) and Manchester Royal Infirmary (65) from January 1993 to
June 1997. Close supervision by a fully trained operator was provided
for at least the first 20 procedures performed by each operator.
Patients94 consecutive patients
underwent electrophysiological study and ablation for
Wolff-Parkinson-White syndrome with left sided accessory connections
(81 patients) or ectopic atrial tachycardia (13 patients); 104 transseptal procedures were done; eight patients required multiple procedures.
Results92 patients (98%) were
initially successfully ablated. Five of 81 with accessory pathways
(6%) and three of 13 with atrial tachycardia (23%) required further
procedures. One patient with Wolff-Parkinson-White syndrome could not
be ablated at a second procedure. Long term success rate for accessory
pathway ablation was therefore 99%. Procedures were abandoned in three
patients because of minor complications. All were subsequently ablated successfully by a transseptal approach on another day.
ConclusionsThe transseptal approach is
safe and effective for ablation of left sided arrhythmias. The
technique has similar success rates to the retrograde transaortic
approach but without the risk of inadvertent damage to the coronary
arteries or aortic valve.
© 1998 by Heart
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