Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Procedures”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 955 records · Page 53Linked to original sources
PubMed2003

Invasive procedures in multiple gestations.

PURPOSE OF REVIEW: The incidence of multiple gestations has increased significantly with advances in assisted reproductive techniques resulting in a concomitant increase in invasive procedures in these pregnancies. Commonly performed invasive procedures include amniocentesis, chorionic villus sampling, multifetal pregnancy reduction, and selective termination. Amniocentesis and chorionic villus sampling are also performed in singleton pregnancies, while multifetal pregnancy reduction and selective termination are procedures that are unique to multiple gestations. RECENT FINDINGS: With increased operator experience, pregnancy loss rates after chorionic villus sampling, multifetal pregnancy reduction, and selective termination have decreased to acceptably low levels. Amniocentesis and chorionic villus sampling continue to have similar loss rates in experienced hands. A recent study suggests that amniocentesis in twins may have a higher post-procedural loss rate than in singletons; this may be due to the higher background loss rate of twins. There has been a recent increase in multifetal pregnancy reduction to a singleton with a trend towards improved outcomes over reduction to twins; future studies should focus on whether this confers a definitive advantage. Newer data suggests that selective termination after 20 weeks gestation in experienced hands does not increase loss rates over those procedures performed before 20 weeks. Newer techniques, such as cord coagulation, continue to be developed for selective termination in monochorionic pregnancies, though still with considerable morbidity and mortality. SUMMARY: In summary, invasive procedures in multiple gestations are now commonly performed with. It is our hope that primary prevention of high order multiple pregnancies by optimization of assisted reproductive techniques will decrease the need for these procedures.

Abortion, Eugenic↗
PubMedDate not supplied

The efficacy and safety of fentanyl for the management of severe procedural pain in patients with burn injuries.

Fentanyl has been shown to be effective for the management of intense pain of short duration. We have recently used intravenous fentanyl for burn wound procedures because of its rapid onset, high potency, and short duration. In this report, we reviewed our experience with fentanyl in a variety of procedural burn pain settings to develop specific recommendations about its effectiveness and safety for the treatment of pain in patients with burn injuries. The medical records of patients with burn injuries who received fentanyl for wound procedures over a 2-year period were retrospectively reviewed. Patient demographics, the amount of fentanyl administered, the level of analgesia achieved, and the incidence of adverse effects were analyzed. Fifty-five patients who were 9 months to 75 years old with burn wounds (range, 1%-90% of total body surface area) received 148 doses of fentanyl for the treatment of procedural pain. An average of 8.0 +/- 7.0 microg/kg of fentanyl (range, 0.7 to 38.0 microg/kg) was required for the first wound procedure with fentanyl. No correlation between dosage of fentanyl given and either age or percentage of total body surface area burned was observed. Transient respiratory depression was observed in 17 patients (31%). No patient required intubation or additional supplemental oxygen after the conclusion of the procedure. High doses of fentanyl are required to achieve adequate analgesia during some burn wound procedures. Respiratory depression associated with fentanyl use is transient but requires adequate preparation and trained personnel. Fentanyl may be effectively integrated into the pain control strategy for patients with burn injuries.

Adolescent↗
PubMed2002

Children's knowledge, anticipatory anxiety, procedural distress, and recall of esophagogastroduodenoscopy.

BACKGROUND: This study evaluates the relations among children's knowledge of esophagogastroduodenoscopy (EGD) and anticipatory anxiety, procedural distress, and the nature of postprocedural recall and evaluations. METHODS: One hundred patients, aged 8 to 17 years, completed self-report measures of knowledge and anxiety before EGD. Parents completed a self-report measure assessing how they prepared their children. Nurses and trained observers completed observational ratings of distress. Children's recall and evaluation of the procedure were assessed by self-report 1 hour after the procedure and by telephone that evening. RESULTS: Most children knew about the major components of EGD. Children with greater knowledge experienced less distress and reported that they would be less anxious and upset when undergoing future EGDs. Children with greater anticipatory anxiety exhibited more procedural distress. Children's distress varied by the phase of the procedure. Children who were more distressed during intravenous line insertion experienced greater distress during esophageal intubation and the endoscopic examination. Approximately 20% of patients reported at least some memory of the procedure even at the end of the day. Children with greater recall reported greater aversion and a more negative attitude toward future EGDs. CONCLUSIONS: This study provides information about children's distress during EGD and the effects of conscious sedation on patients' memories and attitudes toward future procedures. The study indicates that preparation before EGD may reduce patient distress.

Adolescent↗
PubMed2001

Laryngotracheal anastomosis: primary and revised procedures.

OBJECTIVES: Acquired upper airway stenosis is usually associated with a complex of pathological conditions at the high tracheal and the subglottic levels. Reported reconstructive techniques include widening by incorporation of grafts, segmental resection, and anastomosis or combined procedures. The management of recurrent stenosis after reconstructive surgery is a major challenge and has rarely been discussed in the literature. The purposes of the present study are to compare the clinical course of primary versus revised reconstructive procedures and to analyze the effect of age, diabetes, chronic lung disease, grading of stenosis, extent of resection, and revised procedures on the operative rate of success. STUDY DESIGN: A cohort study in a tertiary referral medical center. METHODS: The clinical course of 23 consecutive patients undergoing laryngotracheal anastomosis was studied comparing a group of 13 primary with 10 revision procedures. Seventeen patients underwent cricotracheal and six patients thyrotracheal anastomoses. All patients but one were tracheotomized before the definitive reconstructive procedure. Suprahyoid release was routinely performed except for two cases, and only one patient required sternotomy. The Wilcoxon test was used to examine the relationship between preoperative clinical parameters and the postoperative success (i.e., airway patency). RESULTS: Twenty-two of 23 patients (95.6%) had successful decannulation. Four patients required a revision procedure because of repeat stenosis at the site of the anastomosis (2) or distal tracheal malacia (2). Residual airway stenosis of less than 50% was noted in six patients, although only three complained of dyspnea during daily-activity exertion. There was no associated mortality. Complications included subcutaneous emphysema (4), granulation tissue formation (3), pneumonia (2), cardiac arrhythmia (2), and one each of pneumomediastinum, neck hematoma, and urosepsis. Protracted aspirations were noted in one patient who had revision surgery. Age was the only parameter that correlated with postoperative airway patency (P <.07), whereas the presence of chronic obstructive lung disease and diabetes, grade of stenosis, type of surgery, and revision surgery were found to be insignificant. CONCLUSIONS: The clinical course of laryngotracheal anastomosis in primary and revised procedures was similar in our group of patients. The operation can be performed safely, with an expected high rate of success and acceptable morbidity.

Anastomosis, Surgical↗
PubMed2003

Mucosal plication (Gant-Miwa procedure) with anal encircling for rectal prolapse--a review of the Japanese experience.

Although mucosal plication for rectal prolapse, known as the Gant-Miwa procedure, is described in some English textbooks, it has been infrequently performed in the West. However, this procedure has been used and developed in conjunction with anal encircling in Japan since the 1960s and is still considered to play a major role in the treatment of rectal prolapse. Certain technical details have been found necessary to ensure the success of the procedure, especially in the technique of anal encircling. For example, the use of Teflon tape and routing relatively deeply and outside the external anal sphincter are necessary. Clinical results show a recurrence rate of 0 to 31 percent with no mortality and almost never any serious complications such as significant bleeding or severe sepsis, which are occasionally encountered in other perineal procedures. Most patients report improved continence after this procedure, and worsening of evacuation is rarely encountered based on our experience. Some physiologic studies have shown improved resting pressure and rectal sensation, which can have a positive influence on the defecatory function. We believe that the Gant-Miwa procedure with anal encircling should be considered as a treatment of choice among perineal procedures for rectal prolapse.

Anal Canal↗
PubMed2004

Tarsal strip procedure for the correction of tearing.

PURPOSE: To evaluate the tarsal strip procedure in the treatment of tearing related to lacrimal pump failure. METHODS: A retrospective chart review of all tearing patients undergoing the tarsal strip procedure was done. Patients with ectropion, nasolacrimal duct obstruction, and punctal eversion and stenosis were excluded. Data collected included patient age, sex, procedures performed, follow-up, and resolution of tearing. The main outcome measure is resolution of tearing. RESULTS: Thirty-four eyelids of 21 patients underwent a tarsal strip procedure for the correction of tearing. Complete resolution of tearing was noted in 14 eyes. Seventeen eyes were partially improved and required no further intervention. Three eyes were unimproved over the follow-up period. Two eyes eventually required another procedure. CONCLUSIONS: Patients undergoing tarsal strip for tearing caused by presumed lacrimal pump failure showed a significant rate of improvement in their tearing symptom after the procedure. The tarsal strip procedure appears to be effective in the surgical treatment of tearing secondary to laxity of the lower eyelid.

Aged↗
PubMed2004

The use of stab incisions for instrument access in laparoscopic urological procedures.

PURPOSE: Traditional laparoscopic procedures use expensive cannulas to facilitate the insertion and removal of laparoscopic instruments. We report our experience with limited access stab incisions for the insertion of instruments into the peritoneal cavity during laparoscopic urological procedures to minimize the use of disposable cannulas. MATERIALS AND METHODS: All patients undergoing laparoscopic urologic procedures using stab incisions, as performed by us, from November 1999 through March 2003 were included. Procedures included nephrectomy, partial nephrectomy, varicocelectomy, nephroureterectomy, orchiopexy and adrenal procedures. A single cannula was used for telescope access. In select cases additional cannulas were used for unique instruments or specimen manipulation/extraction. Abdominal wall stab incisions were used for the remaining instruments. Stab incisions were closed with a Steri-Strip (3M Healthcare, St. Paul, Minnesota) at the skin level only. RESULTS: A total of 53 procedures were performed during the study period. Pneumoperitoneum was maintained in all cases. There were no complications associated with the use of stab incisions. A total of 105 cannulas were saved using our technique. At a cost to the patient of dollars 140 per cannula the overall cost saving was dollars 14,700 with an average saving of dollars 277 per case. CONCLUSIONS: Laparoscopic urological procedures can be performed effectively and safely with stab incisions for instrument access. There are significant cost savings related to the elimination of cannulas. We believe that our technique of stab incisions for instrument access is equivalent to the traditional cannula approach and should be used when possible.

Child↗
PubMed2006

Radiation dose and risk from fluoroscopically guided percutaneous transhepatic biliary procedures.

PURPOSE: To estimate radiation dose and associated risks after fluoroscopically guided percutaneous transhepatic biliary (PTB) drainage and stent implantation procedures. MATERIALS AND METHODS: Organ and effective doses, normalized to dose-area product (DAP), were estimated for PTB procedures with use of a Monte Carlo transport code and an adult mathematical phantom. Exposure parameters from 51 consecutive patients were used to determine average examination parameters for biliary drainage and stent implantation procedures. Thermoluminescent dosimeters were used in an anthropomorphic phantom to verify Monte Carlo calculations. Radiation-induced cancer and genetic risks were estimated. RESULTS: The results consist of doses normalized to DAP so patient dose from any technique and x-ray unit can be easily calculated for left and right biliary access and for separate or combined biliary and metallic stent implantation sessions. A good agreement was found between Monte Carlo-calculated data and data derived from thermoluminescent dosimetry. The average effective dose varied from 1.8 to 5.4 mSv depending on procedure approach (left vs right access) and procedure scheme. A maximum effective dose of 13 mSv was estimated for 30 minutes of fluoroscopy. CONCLUSIONS: Doses delivered to patients undergoing PTB procedures are comparable to those that arise from computed tomography protocols. Radiation-induced cancer risk may be considerable for young patients undergoing PTB drainage and stent implantation procedures.

Adult↗
PubMed2006

Sedation with intravenous ketamine and midazolam for painful procedures in children.

BACKGROUND: Children often require relief of pain and anxiety when undergoing painful procedures. The purpose of this study is to evaluate the effectiveness and safety of painful pediatric procedures performed by pediatric intensivist, using the combination of intravenous ketamine and midazolam for sedation and analgesia. METHODS: The records of the patients who received intravenous ketamine-midazolam combination for painful procedures in the pediatric sedation unit of a university hospital over a 3 year period were retrospectively reviewed to determine indications, dosing, assessment of the level of sedation, adverse events, and recovery time for each procedural sedation and analgesia. RESULTS: A total of 227 children aged 4 months to 18 years were admitted to the pediatric sedation unit for a total of 356 procedures. The indications for procedural sedation and analgesia included bone marrow aspiration or biopsy (50.8%), central venous catheter insertion (27%), and others (22%). A total of 46 adverse events (12.9%) were observed. These adverse events included SpO2 below 85% without apnea (n = 14), apnea (n = 3), transient stridor (n = 2), hypertension and tachycardia (n = 8), hypersalivation (n = 6), vomiting (n = 5), hallucinatory emergence reaction (n = 4), and rash (n = 4). There were no adverse outcomes attributable to ketamine and midazolam combination. CONCLUSION: Skilled pediatric intensivists can safely and effectively administer ketamine and midazolam to facilitate painful procedures outside the operating room setting.

Adolescent↗
PubMed2005

Tension-free vaginal tape procedure with manual-tapping method: a potentially useful technique.

AIM: Stress urinary incontinence (SUI) is accompanied by pelvic organ prolapse (POP) in many cases. We investigate a procedure to adjust the level of suspension of the mid-urethra using tension-free vaginal tape (TVT) under general anesthesia at the time of POP repair surgery. METHODS: Preliminary examination carried out prior to this study showed that the pressure stress applied by a surgeon is less than half of that induced using the cough-stress method: the manual-tapping method (MTM) showed an average intravesical urinary leak point pressure (IULPP) of 21.4 mmHg (range 19-23 mmHg), when the cough-stress method demonstrated an average IULPP >52.4 mmHg (range 45-58 mmHg; n = 3). An attempt was made to predict postoperative SUI by packing sponge gauze into the manually replaced vagina preoperatively. If SUI appeared, TVT was added to the repair operation for POP in those patients (n = 11). Lastly, the MTM was used to decide the level of urethral suspension during the TVT procedure following POP repair surgery under general anesthesia (n = 11). RESULTS: Eleven patients underwent the TVT procedure combined with POP repair surgery. The mean postoperative follow-up period was 23.8 months (range 9-40 months). There was no case of post-surgical ischuria. One patient showed a cystocele during the postoperative course. However, all other patients were relieved from the symptoms of POP, and none complained of SUI following the procedure. CONCLUSION: The MTM seems to be a more appropriate indicator by which to adjust the level of urethral suspension during the TVT procedure than the conventional method, particularly under general anesthesia. To prevent and cure perioperative SUI, the MTM as a TVT procedure combined with POP repair surgery under general anesthesia is a useful procedure.

Aged↗
PubMed2005

Self-warming lidocaine/tetracaine patch effectively and safely induces local anesthesia during minor dermatologic procedures.

BACKGROUND: Dermatologic procedures often cause some degree of pain. A self-warming patch containing lidocaine and tetracaine (L/T) was developed to provide topical local anesthesia prior to painful procedures. OBJECTIVES: To evaluate the safety and efficacy of a self-warming L/T patch to provide anesthesia in adult patients undergoing minor dermatologic procedures. METHODS: An active or placebo study drug was placed on adults 30 minutes prior to minor dermatologic surgical procedures in a prospectively randomized, double-blinded manner. Subcutaneous lidocaine injection was available during the procedure as a rescue medication if requested by the subject. Immediately following the procedure, the subjects, the investigator, and an independent observer rated pain intensity and adverse events were recorded. RESULTS: Patient-reported pain intensity was significantly lower in the L/T patch group (p<.001). Investigators and an independent observer rated the pain in the L/T patch group to be less than in the placebo patch group (p = .004 and p<.001, respectively). Forty-nine percent of patients in the placebo group required rescue subcutaneous lidocaine compared with 22% in the L/T patch study group (p = .008). One patient in the L/T patch group reported a transient moderate burning sensation. CONCLUSION: The self-warming L/T patch was effective in providing clinically useful local anesthesia for minor dermatologic procedures in adult patients.

Administration, Cutaneous↗
PubMed1992

Major surgery in nursing home patients: procedures, morbidity, and mortality in the frailest of the frail elderly.

OBJECTIVE: To determine the surgical procedures being done on long-term care (level 2) nursing home residents and the resultant in-hospital morbidity and mortality. DESIGN: A retrospective chart review of inpatient medical records from two hospitals, identified by computerized search of medical records and/or referral by directors of nursing of area nursing homes. SETTING: Patients originated in skilled-care nursing homes in New Castle County, Delaware, USA. Surgery was performed in the area's two major hospitals, one a 1000-bed regional referral and teaching hospital, and the other a 300-bed community hospital. PATIENTS: Residents of skilled-care nursing homes (level 2) who underwent major surgery between January 1979 and December 1989. MEASUREMENTS AND MAIN RESULTS: Eighty procedures were performed in 74 patients. Many different types of procedures were done. After primary repair of hip fracture the most common procedures were non-orthopedic extremity and abdominal surgeries. Three deaths occurred (mortality 3.8%), and all were in patients undergoing emergency surgery who were classified above American Society of Anesthesiology Class 3. Serious complications occurred in 43% of the procedures and were most commonly cardiopulmonary and psychiatric, including profound depression in four. Antibiotic-associated colitis occurred in three patients and required a second surgical procedure in one. Fewer adverse outcomes were seen in patients undergoing elective surgical procedures with spinal or local anesthesia than in patients receiving general anesthesia. CONCLUSIONS: Although retrospective and limited to inpatient data, in-hospital surgical mortality in this very frail population was low, comparable to series in unselected geriatric populations. However, major complications were very common. Primary hip surgery repair may have been too frequently done. A multi-institution, prospective trial would be useful to assess functional outcome of surgery in this population.

Aged↗
PubMed2003

Bispectral electroencephalographic analysis of patients undergoing procedural sedation in the emergency department.

OBJECTIVE: To determine whether there is a correlation between the level of sedation achieved during procedural sedation (PS) in the emergency department as determined by bispectral electroencephalographic (EEG) analysis (BIS) and the rate of respiratory depression (RD), the patient's perception of pain, recall of the procedure, and satisfaction. METHODS: This was a prospective observational study conducted in an urban county hospital of adult patients undergoing PS using propofol, methohexital, etomidate, and the combination of fentanyl and midazolam. Consenting patients were monitored by vital signs, pulse oximetry, nasal-sample end-tidal carbon dioxide (ETCO(2)), and BIS monitors during PS. Respiratory depression (RD) was defined as an oxygen saturation <90%, a change from baseline ETCO(2) of >10 mm Hg, or an absent ETCO(2) waveform at any time during the procedure. After the procedure, patients were asked to complete three 100-mm visual analog scales (VASs) concerning their perception of pain, recall of the procedure, and satisfaction with the procedure. Patients were divided into four groups based on the lowest BIS score recorded during the procedure, group 1, >85; group 2, 70-85; group 3, 60-69; group 4, <60. Rates of RD and VAS outcomes were compared between groups using chi-square statistics. RESULTS: One hundred eight patients were enrolled in the study. No serious adverse events were noted. RD was seen in three of 14 (21.4%) of the patients in group 1, seven of 34 (20.6%) in group 2, 16 of 26 (61.5%) in group 3, and 18 of 34 (52.9%) in group 4. The rate of RD in patients in group 2 was not significantly different from that in group 1 (p = 0.46). The rate of RD in group 2 was significantly lower than that in groups 3 (p = 0.0003) and 4 (p = 0.006). For the VAS data, when group 1 was compared with the combined groups 2, 3, and 4, it had significantly higher rates of pain (p = 0.003) and recall (p = 0.001), and a dissatisfaction rate (p = 0.085) that approached significance. When groups 2, 3, and 4 were compared with chi-square test, there was not a significant difference in pain (p = 0.151), recall (p = 0.27), or satisfaction (p = 0.25). CONCLUSIONS: Patients with a lowest recorded BIS score between 70 and 85 had the same VAS outcomes as more deeply sedated patients and the same rate of RD as less deeply sedated patients. This range of scores represented the optimally sedated patients in this study.

Adolescent↗
PubMed1990

The combined intravaginal sling and tuck operation. An ambulatory procedure for cure of stress and urge incontinence.

Thirty patients with symptoms and signs of stress and urge incontinence were treated with a Combined Intravaginal Sling and Tuck procedure. Primarily, only the first part of the procedure, the Sling operation was undertaken. This procedure creates an artificial pubourethral ligament which is achieved by controlled deposition of collagen around a retropubically implanted, removable, 0.5 cm wide Mersilene tape, inserted through a special tunneler. This part, stage 1 of the combined surgical procedure is mainly performed under local anaesthesia without postoperative catheterization, and early return to work. Urgency symptoms were cured simultaneously with the stress symptoms. The 50% success rate of the sling procedure was improved to 82% when the second part (stage 2) of this operation was undertaken. This procedure, the "Tuck" operation, tightens the suburethral vagina. The results of the combined procedure indicate that both an intact pubourethral ligament and tight suburethral vagina are equally important for cure as proposed in the Integral Theory of Female Urinary Incontinence.

Adult↗
PubMed1991

Management importance of common treatments: contribution of top 20 procedures to surgical workload and cost.

OBJECTIVE: To assess the contribution of the most frequently performed procedures to surgical workload and to evaluate the financial implications. DESIGN: Analysis of data held on the department's computerised clinical information system. SETTING: Department of surgery in a district general hospital. PATIENTS: 4845 patients were treated by surgeons in three consultant firms over an 18 month period and 5346 patients by surgeons in a single firm over a five year period. MAIN OUTCOME MEASURES: Percentage and cumulative percentage contribution to workload in order of frequency by procedure. Costs of the commonest and costliest treatments. RESULTS: Half of the workload of the department was encompassed by eight procedures. Twenty procedures accounted for 70% of the work. For a single firm 20 procedures represented over 80% of all the surgical work. Transurethral prostatectomy was the treatment that consumed most resources (pounds 240,900 for 198 patients in 18 months). The costliest patients were those who had undergone complicated large bowel surgery, vascular reconstructions, or amputation. CONCLUSIONS: Clinicians and managers need to appreciate the importance of the most common surgical procedures. It is vital that performance and costing of these procedures are optimum as they contribute disproportionately to overall results and finance.

England↗
PubMed2006

The safety of single-physician procedural sedation in the emergency department.

BACKGROUND: Previous research has shown the safety of procedural sedation in the emergency department in university settings involving multiple emergency physicians. OBJECTIVE: To examine sedation in the emergency department conducted by a single emergency physician with monitoring by the emergency nurse. METHODS: The Procedural Sedation in the Community Emergency Department Registry is a prospective observational database of procedural sedation cases directed by the emergency physicians. Among other parameters, the registry tracts whether emergency physicians or emergency nurses monitored patient sedation. The incidence of complications and outcomes were compared between these two monitoring groups. RESULTS: 1028 procedural sedations were performed on 977 patients at 14 sites. In 885 (86.1%) cases the emergency physician directed the sedation, and performed the procedure with monitoring by the emergency nurse. Complications occurred in 42 (4.1%) patients, 35 (4.0%) EN monitored patients and 6 (4.2%) EP monitored patients (p>0.7). Procedures were successful in 863 (97.5%) cases monitored by emergency nurses and in 140 (97.9%) patients monitored by emergency physicians (p>0.7). CONCLUSION: Procedural sedation in the emergency department performed by a single emergency physician is safe and effective.

Clinical Competence↗
PubMed1997

Randomised trials of new procedures: problems and pitfalls.

Randomised trials that compare new procedures with established ones must avoid prerandomisation bias and must allocate patients to treatment groups based on objective or quantitative criteria, not on subjective clinical judgment. Risk, length of follow up, and sample size must be used to calculate the statistical power of the study, so that a significant difference between treatments does not remain undetected (a type II error). There should already be sufficient experience with the new procedure so that complication rates have stabilised, and participating operators are equally comfortable with all procedures being studied. Even with the above stipulations, randomised trials that compare medical with procedural treatment pose additional problems (many of which have been omitted from this necessarily brief discussion); few such studies have had a major impact on clinical practice. The most useful randomised studies of procedures are those that compare one procedure with another, or those that assess a specific refinement in an established procedure, such as the use of different anticoagulation regimens for coronary stents. Fortunately, clinically useful information has always been available from non-randomised studies. The recent trend towards meta-analysis of large clinical series can substitute for those randomised studies that are unlikely to be helpful.

Drug Therapy↗
PubMed1998

The transseptal approach for ablation of cardiac arrhythmias: experience of 104 procedures.

OBJECTIVE: To report retrospectively on the training and subsequent experience of two operators in transseptal ablation of arrhythmias arising in the left atrium and left atrioventricular annulus, to show whether, with adequate training and careful attention to detail, this is a safe and effective technique. SETTING: Electrophysiological studies and transseptal procedures were performed in the electrophysiology laboratories of the Moffatt Hospital, University of California at San Francisco (39) and Manchester Royal Infirmary (65) from January 1993 to June 1997. Close supervision by a fully trained operator was provided for at least the first 20 procedures performed by each operator. PATIENTS: 94 consecutive patients underwent electrophysiological study and ablation for Wolff-Parkinson-White syndrome with left sided accessory connections (81 patients) or ectopic atrial tachycardia (13 patients); 104 transseptal procedures were done; eight patients required multiple procedures. RESULTS: 92 patients (98%) were initially successfully ablated. Five of 81 with accessory pathways (6%) and three of 13 with atrial tachycardia (23%) required further procedures. One patient with Wolff-Parkinson-White syndrome could not be ablated at a second procedure. Long term success rate for accessory pathway ablation was therefore 99%. Procedures were abandoned in three patients because of minor complications. All were subsequently ablated successfully by a transseptal approach on another day. CONCLUSIONS: The transseptal approach is safe and effective for ablation of left sided arrhythmias. The technique has similar success rates to the retrograde transaortic approach but without the risk of inadvertent damage to the coronary arteries or aortic valve.

Adolescent↗