Evaluation of adult versus pediatric transesophageal echocardiography probe efficiency for guiding septal puncture during atrial fibrillation ablation

Abstract

PurposeTransesophageal echocardiography (TEE) has a pivotal role in invasive cardiology practice in terms of guiding a variety of procedures. It is challenging to perform TEE examination with sedated patients due to difficulties in cooperation and positioning the patient properly, therefore the risk of complications is escalated. We aimed to assess the impact of pediatric TEE probe utilization on procedural success and complication rates; in comparison with conventional adult TEE probe. MethodsFifty-eight patients undergoing atrial fibrillation (AF) ablation with TEE guidance were enrolled and patients were grouped based on probe size: Group 1 (n=35) included patients undergoing the procedure with adult TEE probe guidance and Group 2 (n=23) included patients with pediatric TEE probe guidance. Procedural success, postprocedural odynophagia and periprocedural intra-oral bleeding frequency, number of intubation attempts, TEE imaging time, and midazolam doses for both groups were compared. ResultsOdynophagia frequency was significantly higher in Group 1 (25.7% [n=9] vs. 0%, P=0.008) besides oral mucosal bleeding was also higher in Group 1, although the difference did not reach statistical significance (5.7% [n=2] vs. 0%, P=0.513). Number of repeated attempts was lower in Group 2 (median, 1; range [3-1] vs. 1, [1-1], P=0.038). Image resolutions and septal puncture success rates were similar for both groups. Total imaging time with TEE was significantly shorter in Group 2 (6.41.8min vs. 3.6 +/- 0.9min, P<0.001). Midazolam dose was lower in Group 2 (7.0 +/- 1.7 vs. 6.2 +/- 1.7, P=0.065). ConclusionUsing TEE probes with smaller size for guiding invasive percutaneous procedures performed in cardiac catheterization laboratory decreased TEE-associated complication rates and enhanced patient comfort without any negative effect on procedural success.