Surgical Electrocautery Facilitated Transseptal Puncture in Children

Abstract

Transseptal puncture facilitated by RF energy can be performed in children routinely and safely.

Transseptal puncture using surgical electrocautery in children and adults with and without complex congenital heart disease

“…The RF system used for TSP in these cases were using commercially available NRG transseptal needle with the RF puncture generator (Baylis medical company). More recently Elayi et al illustrated 13 children with successful TSP with RF energy delivered via surgical electrocautery in structurally normal heart requiring left heart catheterization for arrhythmia ablation . Similarly, in our study 28 of 54 patients (Table ) underwent successful TSP for an EP study and ablation procedure in congenital ( n = 4) and structurally normal heart ( n = 24).…”

“…Several studies have reported the use of RF energy ranging from 8 to 45 W . We consciously chose 10W for the first attempt to minimize complications and progressively increased to 15–25 W for complex thick septum with fibrosis, and synthetic material etc.…”

“…In addition, several surgical techniques using pericardium, synthetic material (Dacron, Teflon) for ASD closure, native tissue with scars or synthetic material used for baffle creation in Senning and Mustard procedure (Transposition of great vessels), lateral tunnel creation, or use of conduits/grafts for extracardiac Fontan in single ventricle patients, further creates challenges in structure, configuration, and orientation of the septum. There are several reports in adults and a few small series in children describing successful alternative methods for TSP using radiofrequency (RF) energy delivered through Nykanen RF wire (Baylis medical company, Montréal, Canada), modified transseptal needle (Baylis medical NRG needle, Baylis medical company, Montréal, Canada) specifically designed for RF delivery from a generator, and recently with simple use of surgical electrocautery needle . This method has not been adequately evaluated in patients with complex atrial septal morphology and CHD.…”

Comparison of a Radiofrequency Powered Flexible Needle with a Classic Rigid Brockenbrough Needle for Transseptal Punctures in Terms of Safety and Efficacy

“…Several series have been reported on improving TSP not only in challenging situations but also routinely [11][12][13][14][15][16]. We describe our experience of utilising a radiofrequency (RF) powered flexible needle (Toronto needle, Baylis Medical Company Inc., Montreal, Canada).…”

“…Electrocautery's effectiveness in difficult cases was reported several times [11,12,14,20]. But the use of electrosurgical pen or radiofrequency ablation catheter directly applied on the needle is not an approved technique and cannot be recommended because it might be responsible for slicing the septum by any part of the needle advanced beyond the dilator tip and for coring a small piece of septum when the open needle goes through it.…”