Transseptal Puncture: Devices, Techniques, and Considerations for Specific Interventions

Sharma, Sharan Prakash; Nalamasu, Rahul; Gopinathannair, Rakesh; Vasamreddy, Chandrasekhar R.; Lakkireddy, Dhanunjaya

doi:10.1007/s11886-019-1136-6

Cited by 23 publications

(19 citation statements)

References 56 publications

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“…However, atrial fibrillation (AF) ablation without fluoroscopy guidance seems relatively complex due to transseptal puncture. e rigid anatomical structure of the foramen ovale, adjacent to the ascending aorta and posterior wall of the right atrium, creates difficulty in transseptal puncture [3].…”

Section: Introductionmentioning

confidence: 99%

Study on the Curative Effect and Safety of Radiofrequency Catheter Ablation of Paroxysmal Atrial Fibrillation via Zero-Fluoroscopy Transseptal Puncture under the Dual Guidance of Electroanatomical Mapping and Intracardiac Echocardiography

Hang

Cheng

Liang

et al. 2021

Cardiology Research and Practice

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Aims. 3D electroanatomical mapping combined with intracardiac echocardiography- (EAM-ICE-) guided transseptal puncture has been proven safe and effective during the radiofrequency catheter ablation (RFCA) procedure used to treat paroxysmal atrial fibrillation (PAF). In this study, we aimed to compare the curative effect and safety of RFCA via F (fluoroscopy) and zero-fluoroscopy transseptal puncture guided by EAM-ICE in patients with PAF. Methods and Results. A prospective study in which 110 patients with PAF were included and assigned to two groups was conducted. Fifty-five (50%) patients were enrolled in the EAM-ICE group, whereas the other 55 (50%) patients were enrolled in the F group. There were no significant differences in baseline characteristics between the two groups. The transseptal duration time was longer in the EAM-ICE group (19.8 ± 3.0 min vs. 8.6 ± 1.2 min, p ≤ 0.01 ); however, fluoroscopy was not used in the EAM-ICE group compared with the F group (0 mGy vs. 109.1 ± 57.9 mGy). Similarly, there was also no significant difference in the recurrence rate of atrial fibrillation between the EAM-ICE and F groups (25.5% vs. 18.2%, p = 0.356 ). Conclusion. RFCA via EAM-ICE-guided zero-fluoroscopy transseptal puncture in patients with PAF is safe and effective for long-term follow-up.

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Section: Introductionmentioning

confidence: 99%

Study on the Curative Effect and Safety of Radiofrequency Catheter Ablation of Paroxysmal Atrial Fibrillation via Zero-Fluoroscopy Transseptal Puncture under the Dual Guidance of Electroanatomical Mapping and Intracardiac Echocardiography

Hang

Cheng

Liang

et al. 2021

Cardiology Research and Practice

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“…This organ arrangement is testament to the challenges of classification and frequent rule exceptions found in contemporary imaging series of the heterotaxy syndromes. 9 Regarding echocardiographic imaging for transseptal puncture, case series suggest improved safety with additional imaging where anatomy is challenging, 10,11 as it was in this case. Transesophageal echocardiography was chosen owing to ease of access through a standard approach and operator familiarity, and it provided invaluable additional information to fluoroscopy.…”

Section: Discussionmentioning

confidence: 82%

Cryoballoon ablation from above, through a prosthetic patch atrial septal defect repair

Fitzgerald

May

Mahmoodi

et al. 2020

HeartRhythm Case Reports

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“…Anticipation and definition of difficult TSP is challenging even with additional preprocedural cardiac imaging. Previous AF ablation procedures and prior surgical or percutaneous interventions in the IAS area increase the risk for difficult TSP (5,15,16). Although punctures with the aid of the RF needle technique that could be considered difficult in our study were low, we experienced no safety or efficacy issues with fluoroless ICE-guided approach.…”

Section: Difficult Transseptal Puncturementioning

confidence: 75%

Intracardiac echocardiography-guided transseptal puncture for flouroless catheter ablation of left-sided tachycardias

Antoli

et al. 2020

Preprint

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Introduction Integration of intracardiac echocardiography (ICE) and 3D electroanatomic mapping (EAM) system allows transseptal punctures (TSP) without the use of fluoroscopy. Compared to fluoroscopy, ICE provides better visualization of the anatomy relevant to TSP and early recognition of complications. The aim was to evaluate efficacy and safety of entirely ICE-guided TSPs in patients who underwent fluoroless catheter ablation of left-sided tachycardias. Methods and results Consecutive 524 adult and pediatric patients referred to our institution from July 2014 to December 2019 were analyzed. Patients with cardiac implantable electronic devices (CIEDs) were also included. All procedures were performed with ICE-guided TSP combined with 3D EAM. Adverse events fol-lowing TSP and within 30 days of the procedure were analyzed. Altogether 949 TSPs (363 double punctures, 76.5%) were performed in 586 fluoroless ablation procedures: 451 (77%) were ablation of atrial fibrillation or atypical flutter, 75 (12.8%) of left-sided accessory pathway, 33 (5.6%) of ventricu-lar tachycardia, and 27 (4.6%) of focal atrial tachycardia. Forty-six (7.8%) procedures were performed in pediatric population and 36 procedures (6.1%) in patients with CIED. Only 2 TSPs were unsuc-cessful (2/949, 0.2%). Overall procedural complication rate was 1.9% (11/586 procedures). There was only 1 TSP related pericardial tamponade (2/949, 0.2%). In CIED patients there was 1 lead dislo-cation following TSP. Conclusion Entirely ICE-guided TSPs for different left-sided tachycardias can be safely and effectively performed in adult and pediatric population without the use of fluoroscopy. However, caution is advised in CIED patients due to possible lead dislocation risk.

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Transseptal Puncture: Devices, Techniques, and Considerations for Specific Interventions

Cited by 23 publications

References 56 publications

Study on the Curative Effect and Safety of Radiofrequency Catheter Ablation of Paroxysmal Atrial Fibrillation via Zero-Fluoroscopy Transseptal Puncture under the Dual Guidance of Electroanatomical Mapping and Intracardiac Echocardiography

Study on the Curative Effect and Safety of Radiofrequency Catheter Ablation of Paroxysmal Atrial Fibrillation via Zero-Fluoroscopy Transseptal Puncture under the Dual Guidance of Electroanatomical Mapping and Intracardiac Echocardiography

Cryoballoon ablation from above, through a prosthetic patch atrial septal defect repair

Intracardiac echocardiography-guided transseptal puncture for flouroless catheter ablation of left-sided tachycardias

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