Adverse events
Overall procedural complication rate was 1.9% (11/586 procedures). We
registered 6 pericardial effusions that occurred after the completion of
CA procedures and resolved spontaneously, causing only prolonged
hospital stay. These pericardial effusions could not be attributed to
TSP. Also, there were two femoral artery pseudoaneurysms requiring
surgical intervention and one transient phrenic nerve palsy causing
disability during the six-month recovery period. Detailed information on
adverse events is provided in Table 3.
Importantly, adverse event rate that could be unequivocally attributed
to the transseptal access was only 0.3% (3/949). Of note, one
transseptal access related adverse event was CIED ventricular lead
dislocation. Lead repositioning was performed during the same
hospitalization. There was only 1 pericardial tamponade requiring
intervention recorded immediately after double TSP was performed (2/949,
0.2%). Since this was a double transseptal puncture and it was not
clear which of the punctures resulted in tamponade, both were registered
as adverse events. The cause for tamponade in this case was probably
inadvertent puncture of the opposite left atrial wall during advancement
of the transseptal needle in the presence of a small left atrium and a
floppy interatrial septum.