ST-segment elevation induced during the transseptal procedure for radiofrequency catheter ablation of atrial fibrillation

Letsas, Κonstantinos P.; Pappas, Loukas K.; Gavrielatos, Gerasimos; Efremidis, Michalis; Sideris, Antonios; Kardaras, Fotios

doi:10.1016/j.ijcard.2006.07.065

Cited by 16 publications

(15 citation statements)

References 11 publications

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“…Chest pain is a common preceding symptom for several reported post-procedural AF ablation complications including pulmonary edema, cardiac ischemia and atrial-esophageal fistula [22][23][24]. Subsequently, more insight into the degree of injury and of cardiac biomarker elevation in the post-ablation setting is needed.…”

Section: Discussionmentioning

confidence: 99%

Trends in inflammatory biomarkers during atrial fibrillation ablation across different catheter ablation strategies

Schmidt

Marschang

Clifford

et al. 2012

International Journal of Cardiology

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Section: Discussionmentioning

confidence: 99%

Trends in inflammatory biomarkers during atrial fibrillation ablation across different catheter ablation strategies

Schmidt

Marschang

Clifford

et al. 2012

International Journal of Cardiology

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“…It has been proposed this is a vagal response to the direct mechanical disruption of the autonomic network of the heart by the catheter during the puncture 26 27. An alternative explanation, however, is a coronary air embolism which may occur by not paying rigorous attention to de-airing the assembly.…”

Section: Complicationsmentioning

confidence: 99%

How to perform a transseptal puncture

Earley

2008

Heart

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The left atrium (LA) is the most difficult cardiac chamber to access percutaneously. Although it can be reached via the left ventricle and mitral valve, manipulation of catheters that have made two 180u turns is cumbersome. The transseptal puncture permits a direct route to the LA via the intraatrial septum and systemic venous system. Previously the technique was used infrequently by cardiologists for mitral valvuloplasty and ablation in the left heart; however, the explosion of interest in catheter ablation of atrial fibrillation (AF) has meant the transseptal puncture is a routine skill of the modern cardiac electrophysiologist. This article looks at the practical aspects of this important procedure, particularly as applied to the cardiac electrophysiologist. HISTORYThe transseptal puncture was developed by Ross, Braunwald and Morrow at the National Heart Institute (now the National Heart, Lung, and Blood Institute), Bethseda in the late 1950s to allow left heart catheterisation, principally for the evaluation of valvular heart disease. 1 Early problems were difficulty cannulating the left ventricle, injecting sufficient volume of contrast for imaging, and inadvertent aortic puncture. Important refinements were made to the needle and catheter such that Brockenbrough's description of the technique in 1962 differs little from that used now. 2 Mullins developed a combined catheter and dilator set designed precisely to fit over the Brockenbrough needle, which gives a smooth taper from the tip of the needle, over the dilator to the shaft of the sheath. 3 The terms Brockenbrough needle and Mullins sheath are often used by operators generically when referring to transseptal needles and sheaths, respectively; however, there is a range of equipment available from several manufacturers, often designed for specific applicationsfor example, catheter ablation of AF. INDICATIONSAccess to the LA is needed for catheter ablation, percutaneous mitral valvuloplasty, and occasionally left heart catheterisation where an accurate haemodynamic assessment of the mitral valve is needed or where access to the left ventricle (LV) is denied by a prosthetic aortic valve. Catheter ablation accounts for the vast majority of these cases and in our institution transseptal puncture has been performed in 651 patients in the electrophysiology (EP) laboratory in the past 2 years (fig 1). Transseptal access is widely used for accessory pathway and ventricular tachycardia ablation; however, the huge increase in its use is due to AF cases. 4 Radiofrequency ablation of atrioventricular accessory pathways that span the mitral valve annulus can be performed via a transseptal puncture (anterogradely) or via the aorta and left ventricle (retrogradely). Observational studies that have compared the two routes have not shown any differences in safety or effectiveness. 5-7 Cardiologists, familiar with left heart catheterisation and coronary angiography, are comfortable using catheters in the aorta and left ventricle and therefore some electrophysiologists pre...

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“…We previously had a case of a patient who collapsed and became unconscious due to severe coronary artery spasm about an hour after the end of an AF ablation procedure. Recently, coronary artery spasm has been reported as a complication of AF ablation . Several mechanisms may explain the coronary artery spasm occurring shortly after AF ablation.…”

Section: Introductionmentioning

confidence: 99%

The Relationship between Paroxysmal Atrial Fibrillation and Coronary Artery Spasm

Kawakami

Ohno

Tanaka

et al. 2013

Pacing Clinical Electrophis

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ST-segment elevation induced during the transseptal procedure for radiofrequency catheter ablation of atrial fibrillation

Cited by 16 publications

References 11 publications

Trends in inflammatory biomarkers during atrial fibrillation ablation across different catheter ablation strategies

Trends in inflammatory biomarkers during atrial fibrillation ablation across different catheter ablation strategies

How to perform a transseptal puncture

The Relationship between Paroxysmal Atrial Fibrillation and Coronary Artery Spasm

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