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Lu Y, Yuan Z, Liu C, Ma S, Shu L, Cai Z. The efficiency and safety of multidetector computed tomography-guided transseptal puncture during atrial fibrillation catheter ablation. J Arrhythm 2024; 40:118-123. [PMID: 38333397 PMCID: PMC10848614 DOI: 10.1002/joa3.12975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/26/2023] [Accepted: 12/03/2023] [Indexed: 02/10/2024] Open
Abstract
Background Transseptal puncture (TSP) is a crucial technique for catheter ablation of atrial fibrillation (AF). Although intracardiac echo (ICE) facilitates a safe and accurate TSP, it is not widely used in developing countries because of the expense. This study evaluated the efficiency and safety of a novel cardiac multidetector computed tomography (MDCT)-guided TSP during AF catheter ablation. Methods The study consisted of two cohorts. In the index cohort, TSP procedure was performed under the guidance of ICE, and we recorded the angulation of right anterior oblique of X-ray projection. In the validation cohort, we compared the efficiency and safety of TSP guided by MDCT-calculated angulation with propensity-score-matched patients who underwent TSP guided by ICE. Results We included 50 patients in the index cohort, and the mean angles of interatrial septum (IAS) measured from MDCT and ICE were 34.8 ± 6.3 and 35.1 ± 6.5, respectively. In the validation cohort, 376 patients were enrolled in the MDCT-guided group and ICE-guided group. Both groups had 1 case of cardiac tamponade. The mean axial plane angle was 35.46 ± 6.17 degrees, which was not influenced by age, gender, BMI, and LA size, while a moderate positive linear correlation between EF and the axial plane angle (R 2 = 0.14, p = .006). Conclusion Cardiac MDCT can provide a clear vision of IAS orientation, and provide the appropriate RAO angle and height for TSP. The efficiency and safety of our MDCT-guided TSP were comparable to ICE-guided TSP, which may serve as an alternative method for TSP with ICE unavailable.
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Affiliation(s)
- Yi Lu
- Department of CardiologySecond Affiliated Hospital of Zhejiang University School of Medicine, Cardiovascular Key Lab of Zhejiang ProvinceHangzhouZhejiangChina
| | - Zhen Yuan
- Department of CardiologySecond Affiliated Hospital of Zhejiang University School of Medicine, Cardiovascular Key Lab of Zhejiang ProvinceHangzhouZhejiangChina
| | - Chunhui Liu
- Department of CardiologySecond Affiliated Hospital of Zhejiang University School of Medicine, Cardiovascular Key Lab of Zhejiang ProvinceHangzhouZhejiangChina
| | - Shenghui Ma
- Department of CardiologySecond Affiliated Hospital of Zhejiang University School of Medicine, Cardiovascular Key Lab of Zhejiang ProvinceHangzhouZhejiangChina
| | - Li Shu
- Department of CardiologySecond Affiliated Hospital of Zhejiang University School of Medicine, Cardiovascular Key Lab of Zhejiang ProvinceHangzhouZhejiangChina
| | - Zhejun Cai
- Department of CardiologySecond Affiliated Hospital of Zhejiang University School of Medicine, Cardiovascular Key Lab of Zhejiang ProvinceHangzhouZhejiangChina
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Hu F, Xu B, Qiao Z, Cheng F, Zhou Z, Zou Z, Zang M, Ding S, Hong J, Xie Y, Zhou Y, Huang J, Pu J. Angioplasty Guidewire-Assisted vs. Conventional Transseptal Puncture for Left Atrial Appendage Occlusion: a multicentre randomized controlled trial. Europace 2023; 25:euad349. [PMID: 38011331 PMCID: PMC10751848 DOI: 10.1093/europace/euad349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/02/2023] [Indexed: 11/29/2023] Open
Abstract
AIMS This study was performed to compare the usability, efficiency, and safety of a modified angioplasty guidewire-assisted transseptal puncture (TSP) technique vs. the conventional approach in facilitating access into the left atrium during left atrial appendage occlusion (LAAO) procedures for the treatment of atrial fibrillation. METHODS AND RESULTS The ADVANCE-LAAO trial (Angioplasty Guidewire-Assisted vs. Conventional Transseptal Puncture for Left Atrial Appendage Occlusion) was an investigator-initiated, prospective, multicentre, randomized controlled trial (NCT05125159). Patients with atrial fibrillation who underwent LAAO were prospectively enrolled from four centres and randomly assigned to an angioplasty guidewire-assisted TSP group (n = 131) or to a conventional Brockenbrough needle TSP group (n = 132). The primary endpoint was the one-time success rate of TSP. We also analysed the TSP procedure time, failure rate of the assigned TSP type, radiation dose, contrast dose, and procedural complications in both groups. All patients in the guidewire-assisted group underwent successful TSP, whereas five in the standard conventional group switched to the guidewire-assisted approach. The guidewire-assisted puncture improved the one-time success rate (92.4 vs. 77.3%, P = 0.001), shortened the TSP procedure time (109.2 ± 48.2 vs. 120.5 ± 57.6 s, P = 0.023), and tended to have a higher rate of good coaxial orientation of the sheath with the left atrial appendage during the LAAO procedure (66.4 vs. 54.5%, P = 0.059). No TSP-related complications occurred in the guidewire-assisted TSP group, whereas two complications occurred in the conventional TSP group. There was no significant difference in the failure rate of the assigned TSP type, the total procedure time, the total radiation dose, the rate of successful LAAO implantation, or the procedural complication rate between the two groups (all P > 0.05). CONCLUSION This study confirmed that angioplasty guidewire-assisted puncture can effectively improve the success rate of TSP during LAAO procedures. This novel technique has high potential for application in interventional therapies requiring TSP.
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Affiliation(s)
- Feng Hu
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160# PuJian Road, Shanghai 200127, China
| | - Bin Xu
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160# PuJian Road, Shanghai 200127, China
| | - Zhiqing Qiao
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160# PuJian Road, Shanghai 200127, China
| | - Fuyu Cheng
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160# PuJian Road, Shanghai 200127, China
| | - Zien Zhou
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160# PuJian Road, Shanghai 200127, China
| | - Zhiguo Zou
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160# PuJian Road, Shanghai 200127, China
| | - Minhua Zang
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160# PuJian Road, Shanghai 200127, China
| | - Song Ding
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160# PuJian Road, Shanghai 200127, China
| | - Jun Hong
- Department of Cardiology, Ningbo Hangzhou Bay Hospital, Ningbo, Zhejiang, China
| | - Yuquan Xie
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160# PuJian Road, Shanghai 200127, China
- Department of Cardiology, Ningbo Hangzhou Bay Hospital, Ningbo, Zhejiang, China
| | - Yong Zhou
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160# PuJian Road, Shanghai 200127, China
- Department of Cardiology, Punan Hospital, Pudong New District, Shanghai, China
| | - JianFeng Huang
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160# PuJian Road, Shanghai 200127, China
- Department of Cardiology, Dachang Hospital, Baoshan District, Shanghai, China
| | - Jun Pu
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160# PuJian Road, Shanghai 200127, China
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Mirwais M, Santangeli P. Atrial Transseptal Catheterisation: Challenging Scenarios and Techniques to Overcome Them. Arrhythm Electrophysiol Rev 2023; 12:e23. [PMID: 37654671 PMCID: PMC10466273 DOI: 10.15420/aer.2022.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 05/03/2023] [Indexed: 09/02/2023] Open
Abstract
Atrial transseptal catheterisation is a fundamental skill of any interventional electrophysiologist. In this review, various scenarios that pose unique challenges to atrial transseptal catheterisation are discussed. These scenarios include post-surgical or congenital malformations of the interatrial septum, presence of interatrial septal closure devices, absent or obstructed inferior vena cava and complex congenital heart disease after palliative surgery. Transseptal catheterisation in all of the above situations is feasible and can be performed safely with the aid of dedicated tools and specific techniques.
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Affiliation(s)
- Maiwand Mirwais
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA, US
| | - Pasquale Santangeli
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA, US
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Brlecic PE, Bonham CA, Rosengart TK, Mathison M. Direct cardiac reprogramming: A new technology for cardiac repair. J Mol Cell Cardiol 2023; 178:51-58. [PMID: 36965701 PMCID: PMC10124164 DOI: 10.1016/j.yjmcc.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 03/03/2023] [Accepted: 03/21/2023] [Indexed: 03/27/2023]
Abstract
Cardiovascular disease is one of the leading causes of morbidity and mortality worldwide, with myocardial infarctions being amongst the deadliest manifestations. Reduced blood flow to the heart can result in the death of cardiac tissue, leaving affected patients susceptible to further complications and recurrent disease. Further, contemporary management typically involves a pharmacopeia to manage the metabolic conditions contributing to atherosclerotic and hypertensive heart disease, rather than regeneration of the damaged myocardium. With modern healthcare extending lifespan, a larger demographic will be at risk for heart disease, driving the need for novel therapeutics that surpass those currently available in efficacy. Transdifferentiation and cellular reprogramming have been looked to as potential methods for the treatment of diseases throughout the body. Specifically targeting the fibrotic cells in cardiac scar tissue as a source to be reprogrammed into induced cardiomyocytes remains an appealing option. This review aims to highlight the history of and advances in cardiac reprogramming and describe its translational potential as a treatment for cardiovascular disease.
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Affiliation(s)
- Paige E Brlecic
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Clark A Bonham
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Todd K Rosengart
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Megumi Mathison
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
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Almendarez M, Alvarez-Velasco R, Pascual I, Alperi A, Moris C, Avanzas P. Transseptal puncture: Review of anatomy, techniques, complications and challenges, a critical view. Int J Cardiol 2022; 351:32-38. [PMID: 35007652 DOI: 10.1016/j.ijcard.2022.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 01/05/2022] [Indexed: 11/05/2022]
Abstract
Transseptal puncture (TSP) was initially described to gain access to the left heart for hemodynamic assessment. Continuous evolution from its origins allows interventionists to perform a myriad of procedures that otherwise would be impossible to accomplish. In the recent years, the number of procedures in cardiology that require TSP has grown exponentially. Namely, transcatheter mitral valve repair and replacement, pulmonary vein isolation and left atrium appendage occlusion. In skilled hands, it is a safe and straightforward procedure; however, a lack of knowledge of the materials, anatomy of the interatrial septum and the technique can be met with life-threatening complications. Therefore, it is imperative that interventional cardiologists master this technique to successfully overcome these obstacles and ensure clinical outcomes in patients requiring TSP. The purpose of the following review is to critically analyze the available evidence regarding TSP, provide a step-by-step approach to the technique, the available materials and tips and tricks to overcome difficulties and manage complications.
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Affiliation(s)
- Marcel Almendarez
- Heart Area. Hospital Universitario Central de Asturias, Avenida de Roma S/N, 33011 Oviedo, Spain; Research Institute of the Principado de Asturias, Avenida de Roma S/N, 33011 Oviedo, Spain
| | - Rut Alvarez-Velasco
- Heart Area. Hospital Universitario Central de Asturias, Avenida de Roma S/N, 33011 Oviedo, Spain; Research Institute of the Principado de Asturias, Avenida de Roma S/N, 33011 Oviedo, Spain
| | - Isaac Pascual
- Heart Area. Hospital Universitario Central de Asturias, Avenida de Roma S/N, 33011 Oviedo, Spain; Research Institute of the Principado de Asturias, Avenida de Roma S/N, 33011 Oviedo, Spain; Department of Medicine, Faculty of Medicine, University of Oviedo, 33006 Oviedo, Spain
| | - Alberto Alperi
- Heart Area. Hospital Universitario Central de Asturias, Avenida de Roma S/N, 33011 Oviedo, Spain; Research Institute of the Principado de Asturias, Avenida de Roma S/N, 33011 Oviedo, Spain
| | - Cesar Moris
- Heart Area. Hospital Universitario Central de Asturias, Avenida de Roma S/N, 33011 Oviedo, Spain; Research Institute of the Principado de Asturias, Avenida de Roma S/N, 33011 Oviedo, Spain; Department of Medicine, Faculty of Medicine, University of Oviedo, 33006 Oviedo, Spain
| | - Pablo Avanzas
- Heart Area. Hospital Universitario Central de Asturias, Avenida de Roma S/N, 33011 Oviedo, Spain; Research Institute of the Principado de Asturias, Avenida de Roma S/N, 33011 Oviedo, Spain; Department of Medicine, Faculty of Medicine, University of Oviedo, 33006 Oviedo, Spain.
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Yu X, Dong Z, Gao L, Lin L, Cui L, Shao W, Yu W, Zhen Z, Yuan Y. Transseptal Approach Versus Transaortic Approach for Catheter Ablation of Left-Sided Accessory Pathways in Children. Front Pediatr 2022; 10:888029. [PMID: 35783318 PMCID: PMC9247647 DOI: 10.3389/fped.2022.888029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/19/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Catheter ablation is recommended to eradicate supraventricular tachycardia caused by left-sided accessory pathways (APs) in children. This study aims to compare the safety and efficacy of the transseptal approach (TS) and aortic approach (TA) for catheter ablation of left-sided APs in a pediatric cohort. METHODS Patients < 18 years of age with left-sided APs who had undergone ablation at Beijing Children's Hospital between 13 January 2018 and 7 January 2020 were included and randomly categorized into either TS or TA group (follow-up for 22 months). In all, 60 patients in TS group and 41 patients in TA group were included in this study. Principal endpoints were success rate, recurrence rate, complications, procedure time, and radiation dose. RESULTS For TS group versus TA group, success rate was observed in 100 versus 97.56% (p = 0.402). The procedure time was 27.0 (32.0-23.0) versus 29.0 (38.0-24.5) min (p = 0.092). The rate of success or the procedure time was similar, but for the patients with Aps located in left posterior septum (LPS) or left posterior lateral (LPL), the TS group had a shorter procedure time compared with TA group (p < 0.01). The radiation dose was 28.0 (20.0-41.75) versus 0 mGy (p < 0.001). After successful ablation, no recurrence and complication were observed in either group. CONCLUSION Both TS and TA for catheter ablation of left-sided Aps were shown to be safe and effective in children. Zero radiation and ease of mastery make TA the preferred choice. TS is recommended to be used by properly trained medical professionals, especially for patient with AP localized in the LPL or LPS. However, TS is a good alternative where patients have aortic lesions or when TA fails.
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Affiliation(s)
- Xia Yu
- Department of Cardiology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Ziyan Dong
- Department of Cardiology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Lu Gao
- Department of Cardiology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Li Lin
- Department of Cardiology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Lang Cui
- Department of Cardiology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Wei Shao
- Department of Cardiology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Wen Yu
- Department of Cardiology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Zhen Zhen
- Department of Cardiology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yue Yuan
- Department of Cardiology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
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7
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Pillai A, Padala SK, Ellenbogen KA, Koneru JN. An Unusual Complication of Transseptal Puncture. JACC Case Rep 2021; 3:41-46. [PMID: 34317466 PMCID: PMC8305646 DOI: 10.1016/j.jaccas.2020.11.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/19/2020] [Accepted: 11/02/2020] [Indexed: 06/01/2023]
Abstract
The interatrial septum is a structure with complex embryological development. The true atrial septum is a circumscribed structure, and transgression outside of this area during transseptal puncture may result in entry into the extracardiac space or aorta that may result in a pericardial effusion or cardiac tamponade. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Ajay Pillai
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Santosh K. Padala
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Kenneth A. Ellenbogen
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jayanthi N. Koneru
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia, USA
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Stauber A, Kornej J, Sepehri Shamloo A, Dinov B, Bacevicius J, Dagres N, Bollmann A, Hindricks G, Sommer P. Impact of single versus double transseptal puncture on outcome and complications in pulmonary vein isolation procedures. Cardiol J 2020; 28:671-677. [PMID: 32207839 DOI: 10.5603/cj.a2020.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 03/18/2020] [Accepted: 03/01/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The aim of the current study was to analyze the impact of single versus double transseptal puncture (TSP) for atrial fibrillation (AF) ablation. METHODS Consecutive patients undergoing AF ablation were prospectively included in the AF ablation registry and were analyzed according to single versus double TSP. RESULTS A total of 478 patients (female 35%, persistent AF 67%) undergoing AF ablation between 01/2014 and 09/2014 were included. Single TSP was performed in 202 (42%) patients, double TSP in 276 (58%) patients. Age, gender, body mass index, CHA2DS2-VASc score, left ventricular ejection fraction and operator experience (experienced operator defined as ≥ 5 years of experience in invasive electrophysiology) were equally distributed between the two groups. Repeat procedures (re-dos) were more frequently performed using single TSP access (p < 0.001). Left atrial (LA) diameter was larger in patients with double TSP (p = 0.001). Procedure duration in single TSP was identical to double TSP procedures (p = 0.823). Radiation duration was similar between the two groups (p = 0.217). There were 49 (10%) patients with complications after catheter ablation. There were no differences between complication rates and TSP type (p = 0.555). Similarly, recurrence rates were comparable between both TSP groups (p = 0.788). CONCLUSIONS There was no clear benefit of single or double TSP in AF ablation.
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Affiliation(s)
- Annina Stauber
- Department of Electrophysiology, Heart Center University Leipzig, Germany.
| | - Jelena Kornej
- Department of Electrophysiology, Heart Center University Leipzig, Germany
| | | | - Boris Dinov
- Department of Electrophysiology, Heart Center University Leipzig, Germany
| | | | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center University Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center University Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center University Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | - Philipp Sommer
- Department of Electrophysiology, Heart Center University Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany.,Clinic of Electrophysiology, Heart and Diabetes Center NRW, University Hospital of Ruhr-University Bochum, Bad Oeynhausen, Germany
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Use of a radiofrequency guidewire to simplify workflow for left atrium access: a case series. J Interv Card Electrophysiol 2019; 59:551-556. [PMID: 31873840 DOI: 10.1007/s10840-019-00615-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 08/25/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Transseptal puncture (TSP) is widely used in catheter-based cardiac procedures to gain left atrial access, but its workflow has remained largely unchanged in the last 50 years. This study evaluated the safety and efficacy of a novel, simplified technique for TSP with a radiofrequency (RF)-powered guidewire that eliminates multiple exchanges required with standard needles. METHODS TSP was performed in 84 patients undergoing left-sided procedures (72 atrial fibrillation ablations [32 RF, 40 cryoballoon], 4 atrial tachycardia ablations, 2 ventricular arrhythmia ablations, 6 left atrial appendage closure) utilizing a stiff, exchange length RF guidewire. Under fluoroscopic and echocardiographic guidance, the RF guidewire was used to facilitate septal puncture with RF energy and provide a rail for advancing catheters to the left atrium without exchange. All procedures were performed under general anesthesia or sedation. RESULTS TSP was achieved in all patients with no complications. The RF guidewire allowed catheters to be tracked back up to the superior vena cava without exchange in cases where another dropdown was desired to locate a preferred puncture site. The stiffness of the wire provided adequate support to advance all sheaths to the left side regardless of outer diameter. CONCLUSION TSP was performed safely and successfully for various left heart procedures with a RF guidewire that served as an RF transseptal device and a stiff guidewire. This allowed for a more efficient and potentially safer technique without the need for re-wiring or an over the wire sheath exchange. This provides substantial savings in both time and materials.
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Bai Y, Zhang S, Qin YW, Zhao XX. Percutaneous occlusion of transseptal puncture-related free wall perforation at the coronary sinus with a ventricular septal occluder during left atrial appendage closure: A case report. Catheter Cardiovasc Interv 2019; 96:E755-E757. [PMID: 31696654 DOI: 10.1002/ccd.28589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/26/2019] [Indexed: 11/09/2022]
Abstract
Coronary sinus perforation is a life-threatening complication of transseptal puncture and needs to be repaired immediately. In this study, we report a case of a 74-year-old female patient with nonvalvular atrial fibrillation, who is a poor long-term anticoagulation candidate. During the manipulation of transseptal puncture, a perforation of the free right atrial wall at the coronary sinus ostium occurred, which was caused by the Brockenbrough needle and followed by the immediate advancement of an 8.5-French transseptal sheath. In consideration of the danger of cardiac tamponade after sheath removal, we decided to leave the 8.5-French sheath in the pericardial cavity. Then, we advanced a 6 mm ventricular septal occluder through the sheath. Finally, we achieved successful deployment of the device and closure of the perforation under the guidance of fluoroscopy and transthoracic echocardiography. Subsequently, the left atrial appendage orifice was occluded with a 21 mm Watchman device. This case illustrates that percutaneous device closure is feasible for inadvertent perforation of the free right atrial wall at the coronary sinus during transseptal puncture and should be considered as an alternative to surgery.
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Affiliation(s)
- Yuan Bai
- Department of Cardiology, ChangHai Hospital, Second Military Medical University, Shanghai, China
| | - Sha Zhang
- Department of Cardiology, ChangHai Hospital, Second Military Medical University, Shanghai, China
| | - Yong-Wen Qin
- Department of Cardiology, ChangHai Hospital, Second Military Medical University, Shanghai, China
| | - Xian-Xian Zhao
- Department of Cardiology, ChangHai Hospital, Second Military Medical University, Shanghai, China
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11
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Chow AWC, Cobb V, Sepahpour A, McCready JW. Transseptal puncture performed with the new needle-free 'SafeSept' guidewire: a multicentre experience. J Interv Card Electrophysiol 2019; 59:29-34. [PMID: 31655956 DOI: 10.1007/s10840-019-00608-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 08/06/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE Increasing numbers of transseptal punctures (TSP) are performed for different cardiac interventions, especially for left atrial (LA) ablation of atrial fibrillation (AF). Significant TSP-related complications may occur even by experienced operators. Any strategies to mitigate these should be adopted. Previous reports have confirmed the safety and efficacy of the first generation nitinol guidewire for TSP. The objective was to assess the safety and efficacy of a new nitinol 'needle free' SafeSept guidewire (NFSG) for TSP. The distal J-shaped tip (0.014 in.) of the NFSG is unchanged in design; however, the shaft is thicker (0.0315 in.) and stiffer. METHODS This is a multicentre study evaluating TSP without a transseptal needle, using the NFSG via a standard transseptal sheath-dilator, in patients with an indication for TSP. RESULTS A total of 145 consecutive unselected patients were studied. The mean patient age was 59 ± 15. Thirty-one (21.4%) were female and 43 (29.7%) had a previous procedure requiring TSP. The mean transverse LA diameter was 4.0 ± 0.8 cm. AF or LA tachycardia comprised the major indication for TSP (n = 115). Transesophageal echocardiography for direct guidance of TSP was utilised in cases performed under general anesthesia (n = 66, 45.5%). LA access by TSP using the NFSG was achieved successfully in 100% of cases after 1.6 ± 2.3 passes. There were no TSP or other major procedural complications. CONCLUSIONS Use of the NFSG appears to be a safe and effective method in performing TSP. The major improvement in the design of the NFSG is that TSP can be performed without a transseptal needle and exchange for a standard guidewire is not required upon establishing LA access.
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Affiliation(s)
- Anthony W C Chow
- Barts Heart Centre, Barts Health NHS Trust, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK.
- The Heart Hospital, University College London Hospital NHS Trust, London, UK.
- The Wellington Hospital, Wellington Place, London, UK.
- Royal Berkshire Hospital, Reading, UK.
| | - Vanessa Cobb
- Barts Heart Centre, Barts Health NHS Trust, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK
- The Heart Hospital, University College London Hospital NHS Trust, London, UK
| | - Ali Sepahpour
- The Heart Hospital, University College London Hospital NHS Trust, London, UK
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Bowers MR, O'Neill PG, Bhaskar R, Aryana A. Three-dimensional electroanatomical mapping to guide transseptal catheterization. HeartRhythm Case Rep 2018; 4:219-221. [PMID: 29928587 PMCID: PMC6007799 DOI: 10.1016/j.hrcr.2018.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Mark R Bowers
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California
| | - Padraig Gearoid O'Neill
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California
| | - Rohit Bhaskar
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California
| | - Arash Aryana
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California
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Salghetti F, Sieira J, Chierchia GB, Curnis A, de Asmundis C. Recognizing and reacting to complications of trans-septal puncture. Expert Rev Cardiovasc Ther 2017; 15:905-912. [PMID: 29161923 DOI: 10.1080/14779072.2017.1408411] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The transseptal puncture (TSP) enables access to the left heart, through the fossa ovalis (FO), both in electrophysiology and in cardiac interventional procedures. TSP is usually safe in experienced hands. Sometimes TSP can be technically demanding and carries the risk of severe complications in approximately 1%. While performing a TSP, every effort should be taken in order to avoid complications. In the event of complications, prompt recognition and reaction are essential and a combined 'heart-team' management may be the most effective approach. Areas covered: Main TSP-related complications are cardiac tamponade, aortic root puncture, embolic stroke, transient ST elevation of inferior leads and iatrogenic atrial septal defect. A challenging TSP may be expected in presence of difficult IAS-FO anatomies, previous TSP, IAS occluder device and previous IAS surgical repair. Use of echo imaging and special needles (ie., radiofrequency needle and J-shaped guidewire) may avoid TSP-related complications in difficult settings. Expert commentary: Some tools are available to help minimize the risks of TSP. However, their availability might be limited. To increase safety of TSP, an adequate training of physicians, identification of patients in whom it might be difficult and a prompt recognition of complications seem to be the most important background.
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Affiliation(s)
- Francesca Salghetti
- a Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing , Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel , Brussels , Belgium.,b Division of Cardiology , Spedali Civili Hospital, Università degli Studi di Brescia , Brescia , Italy
| | - Juan Sieira
- a Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing , Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel , Brussels , Belgium
| | - Gian-Battista Chierchia
- a Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing , Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel , Brussels , Belgium
| | - Antonio Curnis
- b Division of Cardiology , Spedali Civili Hospital, Università degli Studi di Brescia , Brescia , Italy
| | - Carlo de Asmundis
- a Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing , Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel , Brussels , Belgium
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Lee JH, Kim JH, Choi JH, Kim EJ. Left atrial thrombus due to transseptal catheterization simulating solid mass of right atrium. J Cardiothorac Surg 2017; 12:66. [PMID: 28859665 PMCID: PMC5580202 DOI: 10.1186/s13019-017-0628-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 07/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transseptal catheterization has been popularized through ongoing advances in percutaneous procedures, but related complications are known to occur. CASE PRESENTATION A 72 year-old female was admitted with left-sided weakness. In the course of various exams, a rounded and smooth-surfaced solid mass of right atrium was identified. However, a septal aneurysm associated with left atrial mural thrombus was evident intraoperatively. Given that percutaneous transseptal mitral valvotomy had been done 7 years previously, a causal relationship is likely. CONCLUSIONS Prior cardiac intervention should be considered in patients presenting with mass lesions of interatrial septum.
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Affiliation(s)
- Jae Hang Lee
- Department of thoracic and cardiovascular surgery, Dongguk University Ilsan Hospital, Siksa-dong, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-773, South Korea.
| | - Ji-Hyun Kim
- Cardiovascular center, Dongguk University Ilsan Hospital, Goyang, Gyeonggi, South Korea
| | - Jin-Ho Choi
- Department of thoracic and cardiovascular surgery, Dongguk University Ilsan Hospital, Siksa-dong, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-773, South Korea
| | - Eung-Joong Kim
- Department of thoracic and cardiovascular surgery, Dongguk University Ilsan Hospital, Siksa-dong, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-773, South Korea
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15
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Francisco ARG, Infante de Oliveira E, Nobre Menezes M, Carrilho Ferreira P, Canas da Silva P, Nobre Â, Pinto FJ. Combined MitraClip implantation and left atrial appendage occlusion using the Watchman device: A case series from a referral center. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2016.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Combined MitraClip implantation and left atrial appendage occlusion using the Watchman device: A case series from a referral center. Rev Port Cardiol 2017; 36:525-532. [PMID: 28673783 DOI: 10.1016/j.repc.2016.11.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/08/2016] [Accepted: 11/11/2016] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Patients referred for percutaneous transcatheter mitral valve repair using the MitraClip® system frequently have atrial fibrillation, which imposes additional challenges due to the need for oral anticoagulation. Left atrial appendage occlusion is currently regarded as a non-inferior alternative to anticoagulation in patients with non-valvular atrial fibrillation and both high thromboembolic and bleeding risk. Considering that both MitraClip implantation and left atrial appendage occlusion are percutaneous techniques that require transseptal puncture, it is technically attractive to consider their concomitant use. OBJECTIVES We aim to evaluate the feasibility of a combined approach with MitraClip implantation and left atrial appendage occlusion in a single procedure. METHODS We report the first case series regarding this issue, discussing the specific advantages, pitfalls and technical aspects of combining these two procedures. RESULTS Five patients underwent left atrial appendage occlusion with the Watchman® device followed by MitraClip implantation in the same procedure. All patients experienced significant reduction in mitral valve regurgitation of at least two grades, optimal occluder position, no associated complications and significant clinical improvement assessed by NYHA functional class (reduction of at least one functional class, with four patients in class I at one-month follow-up). CONCLUSION In selected patients rejected for surgical mitral valve repair, with atrial fibrillation and increased risk of bleeding and embolic events, a combined approach with MitraClip implantation and left atrial appendage occlusion in a single procedure is feasible, safe and effective.
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O'Brien B, Zafar H, De Freitas S, Sharif F. Transseptal puncture - Review of anatomy, techniques, complications and challenges. Int J Cardiol 2017; 233:12-22. [PMID: 28202256 DOI: 10.1016/j.ijcard.2017.02.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 12/22/2016] [Accepted: 02/01/2017] [Indexed: 12/17/2022]
Abstract
In recent years, the transseptal puncture approach has enabled passage of increasingly large and complex devices into the left atrium. Traditional tools remain effective in creating and dilating the initial puncture, with an acceptable safety profile. Even for skilled operators, the procedure is technically demanding and requires sound understanding of atrial anatomy. Intracardiac echocardiography is useful in cases of previous septal repair, poorly defined fossa ovalis anatomy or when considering patent foramen ovale portal crossing. Iatrogenic atrial septal defect (iASD) is the most commonly encountered long-term complication and there is increasing evidence that larger devices are leading to symptomatic defects. The size of the sheath crossing the septum is the strongest predictor of iASD formation but other factors such as longer procedure times, significant catheter manipulation and high pulmonary pressures also contribute. Transcatheter mitral valve repair involves the use of large 22 Fr catheters which carry alarmingly high rates of defect persistence with precipitation of symptoms and possible influence on mortality. Long-term follow up data, particularly beyond the 12-month period are lacking and resultantly, evidence to guide management is sparse. Refinements of conventional instruments, as well as innovations to puncture the septum without mechanical pressure, herald a progressively safer future for the transseptal technique.
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Affiliation(s)
- Barry O'Brien
- Biomedical Engineering, School of Engineering & Informatics, National University of Ireland (NUI), Galway, Ireland
| | - Haroon Zafar
- Cardiovascular Research Centre Galway, School of Medicine, NUI, Galway, Ireland; School of Medicine, NUI, Galway, Ireland.
| | - Simon De Freitas
- Cardiovascular Research Centre Galway, School of Medicine, NUI, Galway, Ireland; School of Medicine, NUI, Galway, Ireland
| | - Faisal Sharif
- Cardiovascular Research Centre Galway, School of Medicine, NUI, Galway, Ireland; School of Medicine, NUI, Galway, Ireland; Department of Cardiology, University Hospital Galway, Ireland; BioInnovate, Ireland; CÚRAM, SFI Centre for Research in Medical Devices, Galway, Ireland
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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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Mujović N, Marinković M, Marković N, Kocijančić A, Kovačević V, Simić D, Ristić A, Stanković G, Miličić B, Putnik S, Vujisić-Tešić B, Potpara TS. Management and Outcome of Periprocedural Cardiac Perforation and Tamponade with Radiofrequency Catheter Ablation of Cardiac Arrhythmias: A Single Medium-Volume Center Experience. Adv Ther 2016; 33:1782-1796. [PMID: 27554091 PMCID: PMC5055551 DOI: 10.1007/s12325-016-0402-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Indexed: 11/04/2022]
Abstract
Introduction Cardiac tamponade (CT) is a life-threatening complication of radiofrequency ablation (RFA). The course and outcome of CT in low-to-medium volume electrophysiology centers are underreported. Methods We analyzed the incidence, management and outcomes of CT in 1500 consecutive RFAs performed in our center during 2011–2016. Results Of 1500 RFAs performed in 1352 patients (age 55 years, interquartile range: 41–63), 569 were left-sided procedures (n = 406 with transseptal access). Conventional RFA or irrigated RFA was performed in 40.9% and 59.1% of procedures, respectively. Ablation was performed mostly for atrioventricular nodal reentrant tachycardia (25.4%), atrial fibrillation (AF; 18.5%), atrial flutter (18.4%), accessory pathway (16.5%) or idiopathic ventricular arrhythmia (VA; 12.3%), and rarely for structural VA (2.1%). CT occurred in 12 procedures (0.8%): 10 AF ablations, 1 idiopathic VA and 1 typical atrial flutter ablation. Factors significantly associated with CT were older age, pre-procedural oral anticoagulation, left-sided procedures, transseptal access, AF ablation, irrigated RFA and longer fluoroscopy time (on univariate analysis), and AF ablation (on multivariable analysis). The perforation site was located in the left atrium (n = 7), right atrium (n = 3), or in the left ventricle or coronary sinus (n = 1 each). Upon pericardiocentesis, two patients underwent urgent cardiac surgery because of continued bleeding. There was no fatal outcome. During the follow-up of 19 ± 14 months, eight patients were arrhythmia free. Conclusion Incidence of RFA-related CT in our medium-volume center was low and significantly associated with AF ablation. The outcome of CT was mostly favorable after pericardiocentesis, but readily accessible cardiothoracic surgery back-up should be mandatory in RFA centers.
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20
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Picard F, Millán X, de Hemptinne Q, L L'allier P. Direct transatrial pericardiocentesis for tamponade caused by left atrial perforation after trans-septal puncture. BMJ Case Rep 2016; 2016:bcr-2016-216351. [PMID: 27389729 DOI: 10.1136/bcr-2016-216351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Trans-septal puncture is associated with risks of serious complications. We report a case of an obese 52-year-old man with hypertrophic cardiomyopathy who underwent preoperative coronary angiography and cardiac catheterisation complicated by left atrial perforation. We describe a direct transatrial pericardiocentesis approach to treating cardiac tamponade.
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Affiliation(s)
- Fabien Picard
- Interventional Cardiology, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Xavier Millán
- Interventional Cardiology, Montreal Heart Institute, Montreal, Quebec, Canada
| | | | - Philippe L L'allier
- Interventional Cardiology, Montreal Heart Institute, Montreal, Quebec, Canada
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Ayabakan C, Şahin M, Çeliker A. Radiofrequency catheter ablation of left-sided accessory pathways via retrograde aortic approach in children. J Arrhythm 2016; 32:176-80. [PMID: 27354861 PMCID: PMC4913158 DOI: 10.1016/j.joa.2015.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 12/15/2015] [Accepted: 12/25/2015] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND We aimed to analyze the results of retrograde aortic radiofrequency catheter ablation of left-sided accessory pathways in children. METHODS Between January 2010 and September 2014, 25 children who underwent left-sided accessory pathway ablation with a retrograde aortic approach were evaluated retrospectively. RESULTS The mean age of the patients was 11.09±3.71 years. Seventeen patients were male (68%). The mean procedure and fluoroscopy times were 71.54±21.05 min and 31.42±19.57 min, respectively. Radiofrequency energy was delivered with 41.38±15.32 W at 52.38±5.45 °C. Sixteen patients (64%) presented with manifest preexcitation and, 9 had concealed accessory pathways. The location of accessory pathway was left lateral in 16 patients, posteroseptal in 5, left anterolateral in 2, and left posterolateral and left posterior in the remaining 2. The acute success rate was 96%. The patients were followed for a mean of 16.68±18.01 months. There were 2 recurrences. No major complications were observed in the periprocedural period. One patient had groin hematoma, another one had transient severe headache and vomiting. Trivial mitral regurgitation was noted in a patient, which remained the same throughout follow-up. None of the patients developed new aortic regurgitation, pericardial effusion, or thrombi at the site of ablation. CONCLUSIONS The retrograde aortic approach can be safely employed with a high success rate for ablation of left-sided accessory pathways in children.
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Affiliation(s)
- Canan Ayabakan
- Department of Pediatric Cardiology, Baskent University, Istanbul Research Hospital, İstanbul, Turkey
| | - Murat Şahin
- Department of Pediatric Cardiology, Acıbadem University, İstanbul, Turkey
| | - Alpay Çeliker
- Department of Pediatric Cardiology, Acıbadem University, İstanbul, Turkey
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Sharma G, Singh GD, Smith TW, Fan D, Low RI, Rogers JH. Accuracy and procedural characteristics of standard needle compared with radiofrequency needle transseptal puncture for structural heart interventions. Catheter Cardiovasc Interv 2016; 89:E200-E206. [DOI: 10.1002/ccd.26608] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 04/13/2016] [Accepted: 05/02/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Gaurav Sharma
- Division of Cardiovascular Medicine; University of California Davis Medical Center; Sacramento California
| | - Gagan D. Singh
- Division of Cardiovascular Medicine; University of California Davis Medical Center; Sacramento California
| | - Thomas W. Smith
- Division of Cardiovascular Medicine; University of California Davis Medical Center; Sacramento California
| | - Dali Fan
- Division of Cardiovascular Medicine; University of California Davis Medical Center; Sacramento California
| | - Reginald I. Low
- Division of Cardiovascular Medicine; University of California Davis Medical Center; Sacramento California
| | - Jason H. Rogers
- Division of Cardiovascular Medicine; University of California Davis Medical Center; Sacramento California
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23
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Anatomy of the true interatrial septum for transseptal access to the left atrium. Ann Anat 2016; 205:60-4. [DOI: 10.1016/j.aanat.2016.01.009] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 01/23/2016] [Accepted: 01/25/2016] [Indexed: 11/17/2022]
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24
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Wasmer K, Zellerhoff S, Köbe J, Mönnig G, Pott C, Dechering DG, Lange PS, Frommeyer G, Eckardt L. Incidence and management of inadvertent puncture and sheath placement in the aorta during attempted transseptal puncture. Europace 2016; 19:447-457. [DOI: 10.1093/europace/euw037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 02/02/2016] [Indexed: 12/14/2022] Open
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Katritsis GD, Zografos T, Giazitzoglou E, Katritsis DG. Thrombotic cardiac tamponade after transseptal puncture. HeartRhythm Case Rep 2015; 1:39-40. [PMID: 28491507 PMCID: PMC5418531 DOI: 10.1016/j.hrcr.2014.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- George D. Katritsis
- John Radcliffe Hospital, The Oxford University Clinical Academic Graduate School, Oxford, United Kingdom
| | | | | | - Demosthenes G. Katritsis
- Athens Euroclinic, Athens, Greece
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Address reprint requests and correspondence: Dr. Demosthenes Katritsis, Athens Euroclinic, 9 Athanassiadou St, Athens 11521, Greece
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A Brugada-like electrocardiogram pattern induced after radiofrequency catheter ablation of atrial fibrillation. Int J Cardiol 2015; 178:e1-4. [PMID: 25192783 DOI: 10.1016/j.ijcard.2014.08.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 08/17/2014] [Indexed: 11/20/2022]
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