Patient population
In this retrospective study we included 524 consecutive adult and pediatric patients who were referred to our institution from July 2014 to December 2019 requiring TSP for CA of left-sided arrhythmias. Fluoroless approach in our center was gradually implemented for different CA procedures. Consequently, patients with left-sided tachycardias were included in this retrospective study at different points in time with consecutive TSPs thereafter: left-sided supra-ventricular tachycardias (SVTs) since July 2014, AF since March 2015 and left-sided VT since March 2017.
Left sided focal atrial tachycardia (AT), left-sided accessory pathway (AP) mediated tachycardia, atrioventricular nodal reentry tachycardia (AVNRT), or left-sided VT typically received single transseptal access. Patients with AF and left-sided atypical atrial flutters typically received double TSPs, except patients undergoing hybrid (combined surgical and catheter ablation) procedure for AF which received single transseptal access. Typically, the radio-frequency (RF) needle technique was used in difficult TSP cases. Pediatric patients and patients with CIEDs were also included. Each CIED was tested for proper function before and after the procedure to ensure no change in pacing and sensing parameters occurred. Lead visualization during procedures was entirely performed with ICE without fluoroscopy.