Complications of transseptal catheterization for different cardiac procedures

Background: Cardiac tamponade is themain complication of transseptal catheterization that is necessary for a variety of cardiac interventions and electrophysiology procedures. Methods: A retrospective assessment of all consecutive procedures that required transseptal puncture by the same experienced operator (with already >100 previous trans-septal procedures) during the period 2000-2012 was performed. We recorded any puncture-related complications of pericardial effusion and cardiac tamponade (acute or delayed). Results: A total of 393 procedures were retrieved: Group 1 [ablation of left-sided accessory pathways (n = 77), atrioventricular nodal reentry tachycardia-left septal access (AVNRT) (n = 12), and Inoue balloon mitral valvuloplasty (n = 27)], and Group 2 [atrial fibrillation (AF) ablation procedures: ostial pulmonary vein isolation (PVI) (including RF (n = 76) and cryo-balloon (n = 30)), circumferential PVI (n = 51), and combined procedures (n = 120)]. In total, 5 cases of tamponade were recorded, four of them were acute and one delayed (occurring 1 h after the procedure). All tamponade cases occurred only during or after AF ablation procedures (cryo-balloon ablation = 1, circumferential PVI = 2, and combined procedures = 2). In one case emergency atrial repair followingmedian sternotomywas necessary, and in another a surgical drainage through a limited thoracotomywas performed. The other three cases were treated with pericardiocentesis and drainage for 12 h. No patient was on uninterrupted oral anticoagulation during the procedure. Conclusions: AF ablation is associated with a higher incidence of tamponade compared to other procedures that require transseptal access. Such procedures should only be performed in hospitalswith access to emergency surgical support. (C) 2013 Elsevier Ireland Ltd. All rights reserved.