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Morais P, Vilaça JL, Ector J, D'hooge J, Tavares JMRS. Novel Solutions Applied in Transseptal Puncture: A Systematic Review. J Med Device 2017. [DOI: 10.1115/1.4035374] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
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.
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Affiliation(s)
- Pedro Morais
- ICVS/3B's—PT Government Associate Laboratory, Braga/Guimarães 4710-057, Portugal
- Lab on Cardiovascular Imaging and Dynamics, KU Leuven, Leuven 3000, Belgium
- Instituto de Ciência e Inovação em Engenharia Mecânica e Engenharia Industrial, Faculdade de Engenharia, Universidade do Porto, Porto, Portugal
| | - João L. Vilaça
- ICVS/3B's—PT Government Associate Laboratory, Braga/Guimarães 4710-057, Portugal
- DIGARC—Polytechnic Institute of Cávado and Ave, Vila Frescainha S. Martinho Barcelos 4750-810, Portugal
| | - Joris Ector
- Lab on Cardiovascular Imaging & Dynamics, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jan D'hooge
- Lab on Cardiovascular Imaging & Dynamics, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - João Manuel R. S. Tavares
- Instituto de Ciência e Inovação em Engenharia Mecânica e Engenharia Industrial, Departamento de Engenharia Mecânica, Faculdade de Engenharia, Universidade do Porto, Rua Dr. Roberto Frias, s/n, Porto 4200-465, Portugal e-mail:
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Lien Nguyen B, Merino JL, Shachar Y, Estrada A, Doiny D, Castrejon S, Marx B, Johnson D, Marfori W, Gang ES. Non-Fluoroscopic Transseptal Catheterization During Electrophysiology Procedures using a Remote Magnetic Navigation System. J Atr Fibrillation 2013; 6:963. [PMID: 28496914 DOI: 10.4022/jafib.963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 12/04/2013] [Accepted: 12/04/2013] [Indexed: 11/10/2022]
Abstract
Transseptal punctures are commonly performed, and left atrial (LA) access is frequently lost during lengthy, complex electrophysiology (EP) procedures. We describe a new technique for non-fluoroscopic re-crossing the fossa ovalis using a new multielectrode transseptal sheath (TS) and a new remote magnetic catheter navigation system (RMNS) (CGCI System, Magnetecs) that uses 8 rapid external electromagnets for real-time navigation of a magnet-tipped electrode catheter across the initial transseptal puncture site in 5 patients undergoing left-sided ablation procedures. The three-dimensional (3D) position of a 8.5 Fr steerable TS with 5-ring 5-15-15-5-mm spaced distal electrodes (Agilis ES©, St Jude Medical), and site of fossal ovalis crossing were "shadowed landmarks" on a 3D electroanatomic mapping (EAM) system (EnSite/NavXTM, St Jude Medical). The TS-magnetic ablation catheter assembly was pulled-back to the inferior vena cava. EAM landmarks were used with RMNS-guided "manual" and "automated" catheter navigation modalities, until septal crossing was obtained. Transseptal re-crossing was successfully performed in all patients in 6.2±8.1 sec using the "automated" RMNS-guided technique and in 30.4±28.4 sec using the "manual" RMNS-guided technique (p=0.01) without complications. This new RMNS was safely and effectively used to perform non-fluoroscopic transseptal catheterization.
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Affiliation(s)
- Bich Lien Nguyen
- Electrophysiology Section, Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center Los Angeles, California (B.L.N., E.S.G.); Electrophysiology Section, Heart and Great Vessels Department, Umberto I Hospital, Sapienza University of Rome, Italy (B.L.N.); Arrhythmia and Cardiac Electrophysiology Robotic Unit, La Paz University Hospital, Madrid, Spain (J.L.M., A.E., D.D., S.C.); Magnetecs, Corp., Inglewood, California (Y.S., B.M., D.J.); Department of Radiological Sciences, David Geffen School of Medicine at UCLA (W.M.)
| | - Jose L Merino
- Electrophysiology Section, Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center Los Angeles, California (B.L.N., E.S.G.); Electrophysiology Section, Heart and Great Vessels Department, Umberto I Hospital, Sapienza University of Rome, Italy (B.L.N.); Arrhythmia and Cardiac Electrophysiology Robotic Unit, La Paz University Hospital, Madrid, Spain (J.L.M., A.E., D.D., S.C.); Magnetecs, Corp., Inglewood, California (Y.S., B.M., D.J.); Department of Radiological Sciences, David Geffen School of Medicine at UCLA (W.M.)
| | - Yehoshua Shachar
- Electrophysiology Section, Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center Los Angeles, California (B.L.N., E.S.G.); Electrophysiology Section, Heart and Great Vessels Department, Umberto I Hospital, Sapienza University of Rome, Italy (B.L.N.); Arrhythmia and Cardiac Electrophysiology Robotic Unit, La Paz University Hospital, Madrid, Spain (J.L.M., A.E., D.D., S.C.); Magnetecs, Corp., Inglewood, California (Y.S., B.M., D.J.); Department of Radiological Sciences, David Geffen School of Medicine at UCLA (W.M.)
| | - Alejandro Estrada
- Electrophysiology Section, Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center Los Angeles, California (B.L.N., E.S.G.); Electrophysiology Section, Heart and Great Vessels Department, Umberto I Hospital, Sapienza University of Rome, Italy (B.L.N.); Arrhythmia and Cardiac Electrophysiology Robotic Unit, La Paz University Hospital, Madrid, Spain (J.L.M., A.E., D.D., S.C.); Magnetecs, Corp., Inglewood, California (Y.S., B.M., D.J.); Department of Radiological Sciences, David Geffen School of Medicine at UCLA (W.M.)
| | - David Doiny
- Electrophysiology Section, Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center Los Angeles, California (B.L.N., E.S.G.); Electrophysiology Section, Heart and Great Vessels Department, Umberto I Hospital, Sapienza University of Rome, Italy (B.L.N.); Arrhythmia and Cardiac Electrophysiology Robotic Unit, La Paz University Hospital, Madrid, Spain (J.L.M., A.E., D.D., S.C.); Magnetecs, Corp., Inglewood, California (Y.S., B.M., D.J.); Department of Radiological Sciences, David Geffen School of Medicine at UCLA (W.M.)
| | - Sergio Castrejon
- Electrophysiology Section, Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center Los Angeles, California (B.L.N., E.S.G.); Electrophysiology Section, Heart and Great Vessels Department, Umberto I Hospital, Sapienza University of Rome, Italy (B.L.N.); Arrhythmia and Cardiac Electrophysiology Robotic Unit, La Paz University Hospital, Madrid, Spain (J.L.M., A.E., D.D., S.C.); Magnetecs, Corp., Inglewood, California (Y.S., B.M., D.J.); Department of Radiological Sciences, David Geffen School of Medicine at UCLA (W.M.)
| | - Bruce Marx
- Electrophysiology Section, Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center Los Angeles, California (B.L.N., E.S.G.); Electrophysiology Section, Heart and Great Vessels Department, Umberto I Hospital, Sapienza University of Rome, Italy (B.L.N.); Arrhythmia and Cardiac Electrophysiology Robotic Unit, La Paz University Hospital, Madrid, Spain (J.L.M., A.E., D.D., S.C.); Magnetecs, Corp., Inglewood, California (Y.S., B.M., D.J.); Department of Radiological Sciences, David Geffen School of Medicine at UCLA (W.M.)
| | - David Johnson
- Electrophysiology Section, Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center Los Angeles, California (B.L.N., E.S.G.); Electrophysiology Section, Heart and Great Vessels Department, Umberto I Hospital, Sapienza University of Rome, Italy (B.L.N.); Arrhythmia and Cardiac Electrophysiology Robotic Unit, La Paz University Hospital, Madrid, Spain (J.L.M., A.E., D.D., S.C.); Magnetecs, Corp., Inglewood, California (Y.S., B.M., D.J.); Department of Radiological Sciences, David Geffen School of Medicine at UCLA (W.M.)
| | - Wanda Marfori
- Electrophysiology Section, Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center Los Angeles, California (B.L.N., E.S.G.); Electrophysiology Section, Heart and Great Vessels Department, Umberto I Hospital, Sapienza University of Rome, Italy (B.L.N.); Arrhythmia and Cardiac Electrophysiology Robotic Unit, La Paz University Hospital, Madrid, Spain (J.L.M., A.E., D.D., S.C.); Magnetecs, Corp., Inglewood, California (Y.S., B.M., D.J.); Department of Radiological Sciences, David Geffen School of Medicine at UCLA (W.M.)
| | - Eli S Gang
- Electrophysiology Section, Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center Los Angeles, California (B.L.N., E.S.G.); Electrophysiology Section, Heart and Great Vessels Department, Umberto I Hospital, Sapienza University of Rome, Italy (B.L.N.); Arrhythmia and Cardiac Electrophysiology Robotic Unit, La Paz University Hospital, Madrid, Spain (J.L.M., A.E., D.D., S.C.); Magnetecs, Corp., Inglewood, California (Y.S., B.M., D.J.); Department of Radiological Sciences, David Geffen School of Medicine at UCLA (W.M.)
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Mah DY, Miyake CY, Sherwin ED, Walsh A, Anderson MJ, Western K, Abrams DJ, Alexander ME, Cecchin F, Walsh EP, Triedman JK. The use of an integrated electroanatomic mapping system and intracardiac echocardiography to reduce radiation exposure in children and young adults undergoing ablation of supraventricular tachycardia. Europace 2013; 16:277-83. [PMID: 23928735 DOI: 10.1093/europace/eut237] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS Non-fluoroscopic imaging (NFI) devices are increasingly used in ablations. The objective was to determine the utility of intracardiac echocardiography (ICE) in ablating paediatric supraventricular tachycardias (SVTs) and assess whether its integrated use with electroanatomic mapping (EAM) resulted in lower radiation exposure than use of EAM alone. METHODS AND RESULTS Prospective, controlled, single-centre study of patients (pts) age ≥10 years, weight ≥35 kg, with SVT and normal cardiac anatomy. Patients were randomized to ICE + EAM (ICE) or EAM only (no ICE). Both had access to fluoroscopy as needed. Eighty-four pts were enroled (42 ICE, 42 no ICE). Median age was 15 years (range 10.4-23.7 years); 57% had accessory pathways, 42% atrioventricular nodal reentry tachycardia. There was no difference in radiation dose (9 mGy ICE vs. 23 mGy no ICE, P = 0.37) or fluoroscopy time (1.1 min ICE vs. 1.5 min no ICE, P = 0.38). Transseptal punctures were performed in 25 pts (16 ICE, 9 no ICE), with ICE reducing radiation (8 mGy ICE vs. 62 mGy no ICE, P = 0.002) and fluoroscopy time (1.1 min ICE vs. 4.5 min no ICE, P = 0.01). Zero fluoroscopy was achieved in 13 pts (15% of total, 5 ICE, 8 no ICE), and low-dose cases (<50 mGy) in 57 pts (68% of total, 33 ICE, 24 no ICE). Acute success was 95% for ICE, 88% for no ICE. CONCLUSION Use of an integrated EAM/ICE system was no better than EAM alone in limiting radiation, but can be helpful for transseptal punctures. Given the low dose savings, use of ICE may be weighed against its financial cost. Low-fluoroscopy cases are performed in most NFI procedures.
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Affiliation(s)
- Douglas Y Mah
- Department of Cardiology, Boston Children's Hospital and the Department of Pediatrics, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
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