Off the pedal: Fluoroless transseptal puncture in pediatric supraventricular tachycardia ablation

Bradley C. Clark, Kohei Sumihara, Charles I. Berul, Jeffrey P. Moak

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Background: Fluoroless transseptal (TS) puncture may represent the final step toward elimination of fluoroscopy in pediatric supraventricular tachycardia ablation in normal hearts. We aimed to demonstrate the safety and feasibility of fluoroless TS puncture in pediatric patients and compare procedural timing with the fluoroscopic approach. Methods: We performed a retrospective cohort analysis of all TS procedures performed without fluoroscopy at our institution; fluoroless TS procedures were performed under intracardiac echocardiography (ICE) guidance after the creation of a 3D electroanatomic map and identification of fossa ovalis (FO) on 3D map. TS procedure times reported are the time from sheath insertion (8.5F short sheath for ICE catheter and SL-1 for TS needle) to the time of confirmed left atrial access. Prior TS procedures performed by the same operator utilizing a combination of ICE and fluoroscopy and by a second operator utilizing fluoroscopic guidance alone were used for comparison. Results: Fluoroless TS puncture was performed in nine patients (mean age 13.8 years); the site of TS puncture was within 2 mm of the FO identified on the EA map. The mean TS procedure time was 22.2 minutes (range 10–45). There was no significant difference in TS procedure times between the three groups. There were no complications related to any TS procedure. Conclusion: Fluoroless TS procedures utilizing ICE can safely be performed in pediatric patients without adding substantial procedural times compared with those utilizing fluoroscopic guidance.

Original languageEnglish (US)
Pages (from-to)1254-1259
Number of pages6
JournalPACE - Pacing and Clinical Electrophysiology
Issue number11
StatePublished - Nov 2017
Externally publishedYes


  • fluoroscopy
  • intracardiac echocardiography
  • pediatric
  • radiation
  • transseptal puncture

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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