Transseptal puncture using minimally invasive echocardiography during atrial fibrillation ablation

Yorgun

Cardiovascular Therapeutics

et al. 2016

SUMMARYAim: Rotational angiography is a well-known method for the three-dimensional (3-D) reconstruction of left atrium and pulmonary veins during left-sided atrial arrhythmia ablation procedures. In our study, we aimed to review our experience in transseptal puncture (TSP) using 3-D rotational angiography. Methods: We included a total of 271 patients who underwent atrial fibrillation ablation using cryoballoon. Rotational angiography was performed to get the three-dimensional left atrial and pulmonary vein reconstructions using cardiac C-arm computed tomography. The image reconstruction was made using the DynaCT Cardiac software (Siemens, Erlangen, Germany). Results: The mean age of the study population was 61 AE 10 years. The indications for left atrial arrhythmia ablation were paroxysmal AF in 140 patients (52%) and persistent AF patients in 131 (48%) patients. The success rate of TSP using only rotational guidance was (264/271 patients, 97.4%). In the remaining seven patients, transesophageal guidance was used after the initial attempt due to thick interatrial septum in five patients and difficult TSP due to abnormal anatomy and mild pericardial effusion in the remaining two patients. Mean fluoroscopy dosage of the rotational angiography was 4896.4 AE 825.3 lGym 2 . The mean time beginning from femoral vein puncture to TSP was 12.3 AE 5.5 min. Conclusion: TSP guided by rotational angiography is a safe and effective method. Our results indicate that integration of rotational angiographic images into the real-time fluoroscopy can guide the TSP during the procedure.

Section: Discussionmentioning

confidence: 99%

Rotational Angiography Based Three‐Dimensional Left Atrial Reconstruction: A New Approach for Transseptal Puncture

Yorgun

Cardiovascular Therapeutics

et al. 2016

J Innov Cardiac Rhythm Manage.

“…In addition, real-time three-dimensional and minimally invasive transesophageal echocardiography-guided TP have been applied for atrial fibrillation ablation. [16][17][18] Beside repeated TP, left ventricular lead placement may require a side-selective TP. [19][20][21] In some selected procedures a transaortic approach may be an alternative to TP.…”

Section: Discussionmentioning

confidence: 99%

Side-selective Atrial Transseptal Laser Puncture

Weber¹,

Sagerer-Gerhardt²

2013

Safe and reproducibly effective transseptal puncture and access to the left atrium and ventricle has become a prerequisite for practicing invasive electrophysiologists. Frequently, side-selective transseptal puncture is needed for targeting areas of special interest or particular anatomical structures in the left heart. To achieve that goal a variety of techniques by being tested. We report our experience with side-selective interatrial transseptal puncture using the laser technique. A total of 57 side-selective transseptal puncture procedures were attempted in 45 candidates (ages 22-84 years, 23 female) for ablation of various arrhythmias originating from the left side of the heart. Laser impacts of a cw1064 nm laser (Dornier MedTech) at 10 W/ 2 s delivered via the TransLas (LasCor GmbH), a custom-made transseptal puncture catheter set guided by a steerable sheath (Agilis, St. Jude Medical) allowed for successful side-selective left heart access in all of the patients without complications. Side-selective transseptal laser puncture can be achieved safely and is reproducibly effective by using the laser technique as described.

Journal of Medical Devices

“…For instance, catheters at the aorta, coronary sinus (CS) and His bundle are commonly used. Regarding the procedural time, 1 to 15 minutes have been reported [6][7][8][9][10].…”

Section: -Traditional Transseptal Puncture Proceduresmentioning

confidence: 99%

“…In order to overcome the limitations of the procedures only guided by fluoroscopy, several authors exploited the application of new imaging modalities in TSP (Table 5), namely: transesophageal echocardiography (TEE) [19,[33][34][35][36][37][38], intracardiac echocardiography (ICE) [9,[39][40][41][42][43], real-time magnetic resonance (MR) [44] and direct color visualization [45]. Furthermore, needle tracking based on electromagnetic sensors [46] and electroanatomic mapping (EAM) [17,[47][48][49][50][51][52] were also presented.…”

Section: Intra-procedural Guidance Techniquesmentioning

confidence: 99%

Novel Solutions Applied in Transseptal Puncture: A Systematic Review

Morais

Vilaça²,

Ector

et al. 2017

Access to the left atrium is required for several minimally invasive cardiac interventions in the left heart. For this purpose, transseptal puncture (TSP) technique is often performed, perforating the atrial septum under fluoroscopic or/and ultrasound imaging guidance. Although this approach has been used for many years, complications/failures are not uncommon mainly in patients with abnormal atrial anatomy and repeated TSP. Thus, this study presents an overview of methods and techniques that have been proposed to increase the safety and feasibility of the TSP. A systematic review of literature was conducted through the analysis of the articles published between 2008 and 2015. The search was performed in PubMed, Scopus, and ISI Web of Knowledge using the expression “transseptal puncture.” A total of 354 articles were retrieved from the databases, and 64 articles were selected for this review. Moreover, these 64 articles were divided into four categories, namely: (1) incidence studies, (2) intraprocedural guidance techniques, (3) preprocedural planning methods, and (4) surgical instruments. A total of 36 articles focused on incidence studies, 24 articles suggested novel intraprocedural guidance techniques, 5 works focused on preprocedural planning strategies, and 21 works proposed surgical instruments. The novel 3D guidance techniques, radio-frequency surgical instruments, and pre-interventional planning approaches showed potential to overcome the main procedural limitations/complications, through the reduction of the intervention time, radiation, number of failures, and complications.