Results
Altogether 949 TSPs were performed during 586 procedures in 524
patients. Patient characteristics are shown in Table 1. The majority of
procedures were performed for AF or atypical atrial flutter. However,
TSPs in other left-sided arrhythmias were also assessed: VT (5.6%), AT
(4.6%), AP mediated tachycardia and AVNRT with left sided location of
the slow pathway (12.8%). Procedural characteristics are shown in Table
2. 57 patients had two (46 for AF, 3 for atypical atrial flutter, 5 for
AP mediated tachycardia, 2 for focal AT, 1 for VT) and 5 patients had
three procedures (3 for AF, 1 for and 1 for AP mediated tachycardia).
Double TSPs were performed in majority of procedures for AF or atypical
atrial flutter (350/451, 78%) and in a minority of procedures for focal
atrial tachycardia (8/27, 30%) and VT (5/33, 15%). There were no
double TSPs in patients treated for AP mediated tachycardia and AVNRT.
Only few procedures (41/586, 7%) were performed under general
anesthesia; in pediatric patients who were under 14 years of age (22
procedures) and in patients undergoing hybrid ablation for persistent
atrial fibrillation (19 procedures).
Only two TSPs were unsuccessful (2/949, 0.2%), both in patients with
AF. In one patient with prior surgical removal of myxoma the operator
was unable to puncture through the stiff IAS. The transseptal access was
later successfully performed using RF needle technique. In the second
unsuccessful TSP the presence of inferior vena cava filter precluded the
femoral venous access. Subsequently right transjugular access was
attempted but the operator was unable to insert a steerable or
non-steerable long sheath into the left atrial cavity due to acute angle
between the superior vena cava (SVC) and the IAS. Two procedures in
patients with AF were aborted due to a visible mobile structure on the
wire/long sheath/dilator assembly (2/586, 0.3%). In all cases, mapping
and ablation parts of the procedure after successful TSP were performed
completely without the use of fluoroscopy.