3-Dimensional Transseptal Puncture Based on Electrographic Characteristics of Fossa Ovalis

Yu, Rong‐Hui; Liu, Nian; Lu, Jun; Zhao, Xianxian; Hu, Yucai; Zhang, Jianqiang; Xu, Fengqiang; Tang, Ri‐Bo; Bai, Rong; Akar, Joseph G.; Dong, Jianzeng; Ma, Changsheng

doi:10.1016/j.jcin.2020.03.015

Cited by 24 publications

(21 citation statements)

References 20 publications

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“…The amplitude of LA atrial potential was almost over 1 mV except for the fossa ovalis region. The atrial potential characteristic is consistent with electrographic characteristics of the FO which were recently reported by Yu et al 7 They indicated that electrographic characteristics of the FO center are distinct from those of the surrounding regions with atrial electrogram voltage at 0.33 ± 0.21 mV, and the amplitude of atrial potential at the FO annulus was 1.70 ± 0.72 mV. According to the characteristics of the electrical signal and the spatial location of this patient, we identify the AP atrial insertion locates at the anterior edge of left‐side FO, and it is the first report of atrial insertion site at the FO.…”

Section: Discussionsupporting

confidence: 91%

Rare left‐sided accessory pathway successfully ablated with atrial insertion site at the left‐side fossa ovalis

Yang

Huan

Liu

et al. 2022

Cardiovasc electrophysiol

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Introduction: Left-sided accessory pathway (AP) with atrial insertion away from the annulus is an atypical variation. Conventional mapping and ablation performed along mitral annulus (MA) is usually ineffective.Methods: A 14-year-old girl without structural heart disease presented with recurrent episodes of sudden onset palpitations and electrocardiogram (ECG) showed a narrow QRS complex tachycardia.Results: Electrophysiology study (EPS) was done and anterograde atrioventricular reentrant tachycardia (AVRT) with AP was diagnosed. Conventional mapping and ablation performed along TA and MA was failed. 3D-activation mapping found the retrograde atrial insertion site of AP on the left atrium fossa ovalis (FO), and AP was successfully abolished by radiofrequency ablation at that site. Conclusion:As reported, this patient is the first report of ablating a left-sided AP with retrograde atrial insertion on the left atrium FO.

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Section: Discussionsupporting

confidence: 91%

Rare left‐sided accessory pathway successfully ablated with atrial insertion site at the left‐side fossa ovalis

Yang

Huan

Liu

et al. 2022

Cardiovasc electrophysiol

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“…The 3D‐EAM‐guided TSP procedure was pioneered at our institution and has been previously described in detail 3 . Briefly, using a steerable diagnostic catheter (ThermoCool SmartTouch Biosense Webster, Inc.…”

Section: D‐eam‐guided Tspmentioning

confidence: 99%

Catheter ablation of atrial fibrillation in situs inversus dextrocardia: Challenge, improved procedure, outcomes, and literature review

Zhao

Sang

et al. 2021

Pacing Clinical Electrophis

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Introduction Catheter ablation for atrial fibrillation (AF‐CA) in patients with situs inversus dextrocardia (SID) can be challenging because of the contrary anatomy and associated anomalies. Cases and literature regarding AF‐CA in SID are rare and provide little information. Our study aims to present an improved procedure, ablation strategies, and evaluate the safety and outcomes of AF‐CA in patients with AF and SID. Methods A total of 10 patients with AF‐SID (mean age, 60.4 ± 15.7 years; six paroxysmal AF, four persistent atrial fibrillation [PeAF]) were enrolled. For the improved procedure, images obtained by preacquired computed tomography and three‐dimensional electroanatomical mapping, integrating intracardiac echocardiography, and x‐ray imaging data are necessary to optimize the transseptal puncture and ablation procedure. Results All patients successfully underwent 13 AF‐CA procedures without complications, including three patients received repeat procedures. However, two PeAF patients presented sick sinus syndrome (SSS) after the AF‐CA procedure, and one underwent permanent pacemaker implantation therapy during hospitalization. During the follow‐up period (6‐72 months), the outcomes were not favorable: three patients (30%) maintained sinus rhythm (SR) after the initial procedure; after repeated procedures, the overall SR rate was 40% (four patients). Conclusion With the improved strategy, AF‐CA can be safely and effectively performed with low radiation exposure in patients with SID. However, the long‐term outcomes were not favorable, even when managed at a tertiary center by a team of specialists. Moreover, patients with PeAF might also have masked SSS, which should be carefully considered.

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“…One of the safest features added was the introduction of echocardiography that can be transesophageal or intracardiac. Recently, Yu and colleagues proposed a workflow that included the possibility to see the transseptal needle with 3D EAM, but to visualize the needle, the needle needs to be exposed during the pullback [ 22 ]. We have presented a novel workflow that allows to perform a completely zero-fluoroscopy ablation procedure including the transseptal puncture phase, minimizing the risks of complications (see Video on zero-fluoroscopy transeptal puncture workflow).…”

Section: Discussionmentioning

confidence: 99%

Zero-Fluoroscopy Cardiac Ablation: Technology Is Moving Forward in Complex Procedures—A Novel Workflow for Atrial Fibrillation

Bertini

Pompei

Tolomeo

et al. 2021

Biology

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Background and Rationale. A fluoroscopy-based approach to an electrophysiological procedure is widely validated and has been recognized as the gold standard for a long time. The use of fluoroscopy exposes both the healthcare staff and the patient to a non-negligible dose of radiation. To minimize the risks associated with the use of fluoroscopy, it would be reasonable to perform ablation procedures with zero fluoroscopy. This approach is widely used in simple ablation procedures, but not in complex procedures. In atrial fibrillation (AF) ablation procedures, fluoroscopy remains the main technology used, in particular to guide the transseptal puncture. Main results and Implications. We present a workflow to perform a complete zero-fluoroscopy ablation for AF ablation procedures using a 3D electro-anatomical mapping system, intracardiac echocardiography and a novel steerable guiding sheath that can be visualized on the mapping system. We present two cases, one with paroxysmal AF and the other one with persistent AF during which we applied this novel workflow achieving a successful pulmonary vein isolation without complications and complete zero-fluoroscopy exposure.

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3-Dimensional Transseptal Puncture Based on Electrographic Characteristics of Fossa Ovalis

Cited by 24 publications

References 20 publications

Rare left‐sided accessory pathway successfully ablated with atrial insertion site at the left‐side fossa ovalis

Rare left‐sided accessory pathway successfully ablated with atrial insertion site at the left‐side fossa ovalis

Catheter ablation of atrial fibrillation in situs inversus dextrocardia: Challenge, improved procedure, outcomes, and literature review

Zero-Fluoroscopy Cardiac Ablation: Technology Is Moving Forward in Complex Procedures—A Novel Workflow for Atrial Fibrillation

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