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Ghanem R, Barra C, Shapeton AD, Musuku SR. Improving Safety of Transseptal Puncture for Patients with Abnormal Cardiac Anatomy. J Cardiothorac Vasc Anesth 2024; 38:2491-2493. [PMID: 39069385 DOI: 10.1053/j.jvca.2024.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 07/02/2024] [Accepted: 07/04/2024] [Indexed: 07/30/2024]
Affiliation(s)
| | | | - Alexander D Shapeton
- Veterans Affairs Boston Healthcare System, Department of Anesthesia, Critical Care and Pain Medicine; Tufts University School of Medicine, Boston, MA
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2
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Katov L, Teumer Y, Lederbogen K, Melnic R, Rottbauer W, Bothner C, Weinmann-Emhardt K. Transesophageal Echocardiography Improves Precision in Transseptal Puncture Compared to Fluoroscopy in Left Atrial Electrophysiological Procedures. J Clin Med 2024; 13:2476. [PMID: 38731005 PMCID: PMC11084312 DOI: 10.3390/jcm13092476] [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: 03/12/2024] [Revised: 04/10/2024] [Accepted: 04/21/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Complex arrhythmias often arise from the left side of the heart, necessitating established electrophysiological (EP) procedures like 3D-mapping-assisted radiofrequency (RF) ablations or pulmonary vein isolation (PVI). These procedures typically require transseptal access, emphasizing the critical role of achieving an optimal catheter position through a precise transseptal puncture (TSP). Commonly employed imaging methods for TSP guidance include fluoroscopy and interventional echocardiography. Despite their routine use, there is limited evidence on which imaging modality offers superior catheter positioning for EP procedures, and safety concerns regarding transseptal punctures with imaging remain underexplored. This study aims to systematically evaluate the feasibility, safety, and accuracy of echo-guided TSP compared to fluoroscopy-guided TSP. Methods: In this prospective study, 150 consecutive patients undergoing left atrial EP procedures were enrolled between October 2023 and February 2024 at the Ulm University Heart Center. Following optimal fluoroscopy-guided transseptal needle positioning at the interatrial septum, the catheter placement was further verified using transesophageal echocardiography (TEE). Adjustments were made in cases of suboptimal needle positioning observed in TEE. The fluoroscopically achieved septal positions were categorized based on TEE images as optimal, suboptimal, poor, or dangerous. Results: Among the 150 patients included (58.0% male), fluoroscopy achieved optimal, suboptimal, and poor/dangerous positions in 32.7%, 43.3%, and 24.0%, respectively. After TEE-guided adjustments, optimal and suboptimal positions were achieved in 59.3% and 40.7% of patients, respectively. No instances of poor or dangerous transseptal needle positions were observed under TEE guidance. Conclusions: TEE-guided TSP emerges as a feasible, more accurate, and safer imaging method for transseptal punctures in EP procedures.
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Affiliation(s)
| | | | | | | | | | | | - Karolina Weinmann-Emhardt
- Department of Cardiology, Ulm University Heart Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany (W.R.)
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Heidari H, Kanschik D, Maier O, Wolff G, Brockmeyer M, Masyuk M, Bruno RR, Polzin A, Erkens R, Antoch G, Reinartz SD, Werner N, Kelm M, Zeus T, Afzal S, Jung C. A comparison of conventional and advanced 3D imaging techniques for percutaneous left atrial appendage closure. Front Cardiovasc Med 2024; 11:1328906. [PMID: 38596690 PMCID: PMC11002144 DOI: 10.3389/fcvm.2024.1328906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/15/2024] [Indexed: 04/11/2024] Open
Abstract
Background Understanding complex cardiac anatomy is essential for percutaneous left atrial appendage (LAA) closure. Conventional multi-slice computed tomography (MSCT) and transesophageal echocardiography (TEE) are now supported by advanced 3D printing and virtual reality (VR) techniques for three-dimensional visualization of volumetric data sets. This study aimed to investigate their added value for LAA closure procedures. Methods Ten patients scheduled for interventional LAA closure were evaluated with MSCT and TEE. Patient-specific 3D printings and VR models were fabricated based on MSCT data. Ten cardiologists then comparatively assessed LAA anatomy and its procedure relevant surrounding structures with all four imaging modalities and rated their procedural utility on a 5-point Likert scale questionnaire (from 1 = strongly agree to 5 = strongly disagree). Results Device sizing was rated highest in MSCT (MSCT: 1.9 ± 0.8; TEE: 2.6 ± 0.9; 3D printing: 2.5 ± 1.0; VR: 2.5 ± 1.1; p < 0.01); TEE, VR, and 3D printing were superior in the visualization of the Fossa ovalis compared to MSCT (MSCT: 3.3 ± 1.4; TEE: 2.2 ± 1.3; 3D printing: 2.2 ± 1.4; VR: 1.9 ± 1.3; all p < 0.01). The major strength of VR and 3D printing techniques was a superior depth perception (VR: 1.6 ± 0.5; 3D printing: 1.8 ± 0.4; TEE: 2.9 ± 0.7; MSCT: 2.6 ± 0.8; p < 0.01). The visualization of extracardiac structures was rated less accurate in TEE than MSCT (TEE: 2.6 ± 0.9; MSCT: 1.9 ± 0.8, p < 0.01). However, 3D printing and VR insufficiently visualized extracardiac structures in the present study. Conclusion A true 3D visualization in VR or 3D printing provides an additional value in the evaluation of the LAA for the planning of percutaneous closure. In particular, the superior perception of depth was seen as a strength of a 3D visualization. This may contribute to a better overall understanding of the anatomy. Clinical studies are needed to evaluate whether a more comprehensive understanding through advanced multimodal imaging of patient-specific anatomy using VR may translate into improved procedural outcomes.
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Affiliation(s)
- Houtan Heidari
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Dominika Kanschik
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Oliver Maier
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Georg Wolff
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Maximilian Brockmeyer
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Maryna Masyuk
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Raphael Romano Bruno
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Amin Polzin
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Ralf Erkens
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Sebastian Daniel Reinartz
- Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Nikos Werner
- Department of Cardiology, Heartcenter Trier, Krankenhaus der Barmherzigen Brüder, Trier, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
- CARID (Cardiovascular Research Institute Düsseldorf), Düsseldorf, Germany
| | - Tobias Zeus
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Shazia Afzal
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
- Department of Cardiology, Heartcenter Trier, Krankenhaus der Barmherzigen Brüder, Trier, Germany
| | - Christian Jung
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
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4
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Thompson NA, Shin S, Kocheril AG, Hsiao-Wecksler ET, Krishnan G. Design and Validation of a Soft Robotic Simulator for Transseptal Puncture Training. IEEE Trans Biomed Eng 2023; 70:3003-3014. [PMID: 37220031 DOI: 10.1109/tbme.2023.3278651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE Transseptal puncture (TP) is the technique used to access the left atrium of the heart from the right atrium during cardiac catheterization procedures. Through repetition, electrophysiologists and interventional cardiologists experienced in TP develop manual skills to navigate the transseptal catheter assembly to their target on the fossa ovalis (FO). Cardiology fellows and cardiologists that are new to TP currently train on patients to develop this skill, resulting in increased risk of complications. The goal of this work was to create low-risk training opportunities for new TP operators. METHODS We developed a Soft Active Transseptal Puncture Simulator (SATPS), designed to match the dynamics, static response, and visualization of the heart during TP. The SATPS includes three subsystems: (i) A soft robotic right atrium with pneumatic actuators mimics the dynamics of a beating heart. (ii) A fossa ovalis insert simulates cardiac tissue properties. (iii) A simulated intracardiac echocardiography environment provides live visual feedback. Subsystem performance was verified with benchtop tests. Face and content validity were evaluated by experienced clinicians. RESULTS Subsystems accurately represented atrial volume displacement, tenting and puncture force, and FO deformation. Passive and active actuation states were deemed suitable for simulating different cardiac conditions. Participants rated the SATPS as realistic and useful for training cardiology fellows in TP. CONCLUSION The SATPS can help improve catheterization skills of novice TP operators. SIGNIFICANCE The SATPS could provide novice TP operators the opportunity to improve their TP skills before operating on a patient for the first time, reducing the likelihood of complications.
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Topalović M, Jan M, Kalinšek TP, Žižek D, Štublar J, Rus R, Kuhelj D. Zero-Fluoroscopy Catheter Ablation of Supraventricular Tachycardias in the Pediatric Population. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1513. [PMID: 37761474 PMCID: PMC10527735 DOI: 10.3390/children10091513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023]
Abstract
Catheter ablation (CA) of supraventricular tachycardias (SVTs) is conventionally performed with the aid of X-ray fluoroscopy. Usage of a three-dimensional (3D) electro-anatomical mapping (EAM) system and intracardiac echocardiography (ICE) enables zero-fluoroscopy ablation, eliminating the harmful effects of radiation. We retrospectively analyzed the feasibility, effectiveness and safety of zero-fluoroscopy radiofrequency and cryoablation of various types of SVTs in pediatric patients. Overall, in 171 consecutive patients (12.5 ± 3.9 years), 175 SVTs were diagnosed and 201 procedures were performed. The procedural success rate was 98% (193/197), or more precisely, 100% (86/86) for AVNRT, 95.8% (91/95) for AVRT, 94.1% (16/17) for AT and 100% (2/2) for AFL. No complications were recorded. Follow-up was complete in 100% (171/171) of patients. During the mean follow-up period of 488.4 ± 409.5 days, 98.2% of patients were arrhythmia-free with long-term success rates of 98.7% (78/79), 97.5% (78/80), 100% (13/13) and 100% (2/2) for AVNRT, AVRT, AT and AFL, respectively. Zero-fluoroscopy CA of various types of SVTs in the pediatric population is a feasible, effective and safe treatment option.
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Affiliation(s)
- Mirko Topalović
- Cardiology Department, Pediatric Clinic, University Medical Centre Ljubljana, Bohoriceva 20, 1000 Ljubljana, Slovenia
| | - Matevž Jan
- Cardiovascular Surgery Department, Surgical Clinic, University Medical Centre Ljubljana, Zaloska 7, 1000 Ljubljana, Slovenia (T.P.K.); (J.Š.)
| | - Tine Prolič Kalinšek
- Cardiovascular Surgery Department, Surgical Clinic, University Medical Centre Ljubljana, Zaloska 7, 1000 Ljubljana, Slovenia (T.P.K.); (J.Š.)
| | - David Žižek
- Cardiology Department, Internal Medicine Clinic, University Medical Centre Ljubljana, Zaloska 7, 1000 Ljubljana, Slovenia;
| | - Jernej Štublar
- Cardiovascular Surgery Department, Surgical Clinic, University Medical Centre Ljubljana, Zaloska 7, 1000 Ljubljana, Slovenia (T.P.K.); (J.Š.)
| | - Rina Rus
- Cardiology Department, Pediatric Clinic, University Medical Centre Ljubljana, Bohoriceva 20, 1000 Ljubljana, Slovenia
| | - Dimitrij Kuhelj
- Clinical Institute of Radiology, University Medical Centre Ljubljana, Zaloska 7, 1000 Ljubljana, Slovenia;
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Debreceni D, Janosi K, Bocz B, Turcsan M, Lukacs R, Simor T, Antolič B, Vamos M, Komocsi A, Kupo P. Zero fluoroscopy catheter ablation for atrial fibrillation: a systematic review and meta-analysis. Front Cardiovasc Med 2023; 10:1178783. [PMID: 37396578 PMCID: PMC10313423 DOI: 10.3389/fcvm.2023.1178783] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/07/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Catheter ablation for atrial fibrillation (AF) is the most frequently performed cardiac ablation procedure worldwide. The majority of ablations can now be performed safely with minimal radiation exposure or even without the use of fluoroscopy, thanks to advances in 3-dimensional electroanatomical mapping systems and/or intracardiac echocardiography. The aim of this study was to conduct a meta-analysis to compare the effectiveness of zero fluoroscopy (ZF) versus non-zero fluoroscopy (NZF) strategies for AF ablation procedures. Methods Electronic databases were searched and systematically reviewed for studies comparing procedural parameters and outcomes of ZF vs. NZF approaches in patients undergoing catheter ablation for AF. We used a random-effects model to derive the mean difference (MD) and risk ratios (RR) with a 95% confidence interval (CI). Results Our meta-analysis included seven studies comprising 1,593 patients. The ZF approach was found to be feasible in 95.1% of patients. Compared to the NZF approach, the ZF approach significantly reduced procedure time [mean difference (MD): -9.11 min (95% CI: -12.93 to -5.30 min; p < 0.01)], fluoroscopy time [MD: -5.21 min (95% CI: -5.51 to -4.91 min; p < 0.01)], and fluoroscopy dose [MD: -3.96 mGy (95% CI: -4.27 to -3.64; p < 0.01)]. However, there was no significant difference between the two groups in terms of total ablation time [MD: -104.26 s (95% CI: -183.37 to -25.14; p = 0.12)]. Furthermore, there was no significant difference in the acute [risk ratio (RR): 1.01, 95% CI: 1.00-1.02; p = 0.72] and long-term success rates (RR: 0.96, 95% CI: 0.90-1.03; p = 0.56) between the ZF and NZF methods. The complication rate was 2.76% in the entire study population and did not differ between the groups (RR: 0.94, 95% CI: 0.41-2.15; p = 0.89). Conclusion The ZF approach is a feasible method for AF ablation procedures. It significantly reduces procedure time and radiation exposure without compromising the acute and long-term success rates or complication rates.
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Affiliation(s)
| | - Kristof Janosi
- Heart Institute, Medical School, University of Pecs, Pecs, Hungary
| | - Botond Bocz
- Heart Institute, Medical School, University of Pecs, Pecs, Hungary
| | - Marton Turcsan
- Heart Institute, Medical School, University of Pecs, Pecs, Hungary
| | - Reka Lukacs
- Heart Institute, Medical School, University of Pecs, Pecs, Hungary
| | - Tamas Simor
- Heart Institute, Medical School, University of Pecs, Pecs, Hungary
| | - Bor Antolič
- Department of Cardiology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Mate Vamos
- Cardiac Electrophysiology Division, Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - Andras Komocsi
- Heart Institute, Medical School, University of Pecs, Pecs, Hungary
| | - Peter Kupo
- Heart Institute, Medical School, University of Pecs, Pecs, Hungary
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7
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Maclean E, Mahtani K, Roelas M, Vyas R, Butcher C, Ahluwalia N, Honarbakhsh S, Creta A, Finlay M, Chow A, Earley MJ, Sporton S, Lowe MD, Sawhney V, Ezzat V, Ahsan S, Khan F, Dhinoja M, Lambiase PD, Schilling RJ, Hunter RJ, Segal OR. Transseptal puncture for left atrial ablation: risk factors for cardiac tamponade and a proposed causative classification system. J Cardiovasc Electrophysiol 2022; 33:1747-1755. [PMID: 35671359 PMCID: PMC9543389 DOI: 10.1111/jce.15590] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/28/2022] [Accepted: 04/06/2022] [Indexed: 12/01/2022]
Abstract
Aims Cardiac tamponade is a high morbidity complication of transseptal puncture (TSP). We examined the associations of TSP‐related cardiac tamponade (TRCT) for all patients undergoing left atrial ablation at our center from 2016 to 2020. Methods and Results Patient and procedural variables were extracted retrospectively. Cases of cardiac tamponade were scrutinized to adjudicate TSP culpability. Adjusted multivariate analysis examined predictors of TRCT. A total of 3239 consecutive TSPs were performed; cardiac tamponade occurred in 51 patients (incidence: 1.6%) and was adjudicated as TSP‐related in 35 (incidence: 1.1%; 68.6% of all tamponades). Patients of above‐median age [odds ratio (OR): 2.4 (1.19–4.2), p = .006] and those undergoing re‐do procedures [OR: 1.95 (1.29–3.43, p = .042] were at higher risk of TRCT. Of the operator‐dependent variables, choice of transseptal needle (Endrys vs. Brockenbrough, p > .1) or puncture sheath (Swartz vs. Mullins vs. Agilis vs. Vizigo vs. Cryosheath, all p > .1) did not predict TRCT. Adjusting for operator, equipment and demographics, failure to cross the septum first pass increased TRCT risk [OR: 4.42 (2.45–8.2), p = .001], whilst top quartile operator experience [OR: 0.4 (0.17–0.85), p = .002], transoesophageal echocardiogram [TOE prevalence: 26%, OR: 0.51 (0.11–0.94), p = .023], and use of the SafeSept transseptal guidewire [OR: 0.22 (0.08–0.62), p = .001] reduced TRCT risk. An increase in transseptal guidewire use over time (2016: 15.6%, 2020: 60.2%) correlated with an annual reduction in TRCT (R2 = 0.72, p < .001) and was associated with a relative risk reduction of 70%. Conclusions During left atrial ablation, the risk of TRCT was reduced by operator experience, TOE‐guidance, and use of a transseptal guidewire, and was increased by patient age, re‐do procedures, and failure to cross the septum first pass.
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Affiliation(s)
- E Maclean
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK.,William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - K Mahtani
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - M Roelas
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - R Vyas
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - C Butcher
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - N Ahluwalia
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - S Honarbakhsh
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - A Creta
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - M Finlay
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - A Chow
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - M J Earley
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - S Sporton
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - M D Lowe
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - V Sawhney
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - V Ezzat
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - S Ahsan
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - F Khan
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - M Dhinoja
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - P D Lambiase
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - R J Schilling
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK.,William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - R J Hunter
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK.,William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - O R Segal
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
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Blockhaus C, Waibler H, Guelker J, Klues H, Bufe A, Seyfarth M, Koektuerk B, Shin D. Transesophageal echocardiography guided transseptal puncture and nadir temperatures in cryoballoon pulmonary vein isolation. J Arrhythm 2022; 38:238-244. [PMID: 35387133 PMCID: PMC8977571 DOI: 10.1002/joa3.12679] [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: 11/09/2021] [Revised: 12/27/2021] [Accepted: 01/10/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Cryoballoon (CB) guided pulmonary vein isolation (PVI) is an established procedure in the treatment of atrial fibrillation (AF). Transseptal access is an indispensable step during PVI and may be associated with severe complications. For specific interventions, specific puncture sites of the fossa ovalis are advantageous. Here, we analyzed the potential impact of a transesophageal echocardiography (TOE) guided transseptal puncture on nadir temperatures in CB PVI. Methods and Results We retrospectively analyzed 209 patients undergoing CB PVI in our hospital. The use of TOE had been at the operator's discretion. No TOE-related complications such as perforation of the pharynx or esophagus or loss of teeth were noted. Concerning the applied freezes, we found significantly lower nadir temperatures in all PVs in the TOE group than in the non-TOE group. Procedure time and fluoroscopy time and complications were similar in both groups. Conclusion TOE-guided TSP in CB PVI is safe and feasible. Our study found significantly lower nadir temperatures of CB freezes after TOE-guided TSP which potentially underscores the value of a more infero-anterior puncture site.
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Affiliation(s)
- Christian Blockhaus
- Department of CardiologyHeart Centre NiederrheinHelios ClinicKrefeldGermany
- Witten‐Herdecke UniversityWittenGermany
| | - Hans‐Peter Waibler
- Department of CardiologyHeart Centre NiederrheinHelios ClinicKrefeldGermany
| | - Jan‐Erik Guelker
- Witten‐Herdecke UniversityWittenGermany
- Department of CardiologyPetrus HospitalWuppertalGermany
| | - Heinrich Klues
- Department of CardiologyHeart Centre NiederrheinHelios ClinicKrefeldGermany
| | - Alexander Bufe
- Department of CardiologyHeart Centre NiederrheinHelios ClinicKrefeldGermany
- Witten‐Herdecke UniversityWittenGermany
| | - Melchior Seyfarth
- Witten‐Herdecke UniversityWittenGermany
- Department of CardiologyHelios University HospitalWuppertalGermany
| | - Buelent Koektuerk
- Department of CardiologyHeart Centre NiederrheinHelios ClinicKrefeldGermany
- Witten‐Herdecke UniversityWittenGermany
| | - Dong‐In Shin
- Department of CardiologyHeart Centre NiederrheinHelios ClinicKrefeldGermany
- Witten‐Herdecke UniversityWittenGermany
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9
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Vernemmen I, Vera L, Van Steenkiste G, Deserranno B, Muylle S, Decloedt A, van Loon G. Right atrial-related structures in horses of interest during electrophysiological studies. Equine Vet J 2020; 53:1210-1217. [PMID: 33368591 DOI: 10.1111/evj.13413] [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: 08/03/2020] [Revised: 11/16/2020] [Accepted: 12/17/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Arrhythmias are common in horses, but catheter-based minimally invasive electrophysiological studies and therapeutic interventions have been poorly explored in equine medicine, partly due to the lack of detailed anatomical knowledge of the equine heart. OBJECTIVES To describe the dimensions and anatomical features of some electrophysiologically important landmarks of the right atrium in detail and assess their correlation with bodyweight and aortic diameter. STUDY DESIGN Ex vivo cadaveric study. METHODS Twenty-one hearts of Warmblood horses, subjected to euthanasia for noncardiovascular reasons, were examined post-mortem. The dimensions and anatomical features of the coronary sinus, the great cardiac vein and the oval fossa were recorded. Spearman's Rho correlation coefficients were calculated for correlations between the quantitative parameters and bodyweight and aortic diameter. RESULTS Median dimensions for coronary sinus, great cardiac vein and oval fossa were obtained. A Thebesian valve, partially covering the ostium of the coronary sinus, was present in 9 of the 21 hearts. A median of 6.5 (range 4-9) valves were present in the great cardiac vein. Several parameters, among which the dimensions of the oval fossa and the length of the great cardiac vein, were significantly positively correlated with bodyweight and aortic diameter. MAIN LIMITATIONS Measurements do not consider the dynamic changes during the cardiac cycle as measurements were performed ex vivo. All specimens were retrieved from Warmblood horses, therefore measurements might not apply to other breeds. CONCLUSIONS This study delivers a detailed description of important right atrial-related structures, necessary for the development of minimally invasive intracardiac procedures in horses. Adequate imaging techniques will have to be explored in order to guide these procedures.
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Affiliation(s)
- Ingrid Vernemmen
- Equine Cardioteam Ghent University, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Lisse Vera
- Equine Cardioteam Ghent University, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Glenn Van Steenkiste
- Equine Cardioteam Ghent University, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Bram Deserranno
- Equine Cardioteam Ghent University, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Sofie Muylle
- Department of Morphology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Annelies Decloedt
- Equine Cardioteam Ghent University, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Gunther van Loon
- Equine Cardioteam Ghent University, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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10
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Transesophageal echocardiography in the pediatric interventional cardiac catheterization laboratory. PROGRESS IN PEDIATRIC CARDIOLOGY 2020. [DOI: 10.1016/j.ppedcard.2020.101266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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11
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Žižek D, Antolič B, Prolič Kalinšek T, Štublar J, Kajdič N, Jelenc M, Jan M. Intracardiac echocardiography-guided transseptal puncture for fluoroless catheter ablation of left-sided tachycardias. J Interv Card Electrophysiol 2020; 61:595-602. [PMID: 32860178 DOI: 10.1007/s10840-020-00858-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 08/25/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Integration of intracardiac echocardiography (ICE) and 3D electroanatomic mapping (EAM) system allows transseptal punctures (TSP) without the use of fluoroscopy. Compared with 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 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 following TSP and within 30 days of the procedure were analyzed. RESULTS 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 ventricular 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 unsuccessful (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 dislocation following TSP. CONCLUSIONS 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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Affiliation(s)
- David Žižek
- Cardiology Department, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia.
| | - Bor Antolič
- Cardiology Department, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
| | - Tine Prolič Kalinšek
- Cardiovascular Surgery Department, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Jernej Štublar
- Cardiology Department, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
| | - Nina Kajdič
- Cardiology Department, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
| | - Matija Jelenc
- Cardiovascular Surgery Department, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Matevž Jan
- Cardiovascular Surgery Department, University Medical Centre Ljubljana, Ljubljana, Slovenia
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12
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Penela D, Jáuregui B, Berruezo A. Intracardiac Versus Transesophageal Echocardiography: If You Don't Compare Them You Don't Have the Answer. JACC Clin Electrophysiol 2020; 6:880-881. [PMID: 32703575 DOI: 10.1016/j.jacep.2020.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/16/2020] [Indexed: 10/23/2022]
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13
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Aksu T, Yalin K, Guler TE, Bozyel S, Heeger CH, Tilz RR. Acute Procedural Complications of Cryoballoon Ablation: A Comprehensive Review. J Atr Fibrillation 2019; 12:2208. [PMID: 32435335 DOI: 10.4022/jafib.2208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/14/2019] [Accepted: 08/26/2019] [Indexed: 12/15/2022]
Abstract
Catheter ablation is increasingly performed for treatment of atrial fibrillation (AF). Balloon based procedures have been developed aiming at safer, easier and more effective treatment as compared to point to point ablation. In the present review article, we aimed to discuss acute procedural complications of cryoballoon ablation.
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Affiliation(s)
- Tolga Aksu
- Department of Cardiology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Kivanc Yalin
- Istanbul University- Cerrahpasa, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey.,University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Tumer Erdem Guler
- Department of Cardiology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Serdar Bozyel
- Department of Cardiology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Christian-H Heeger
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Roland R Tilz
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany
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14
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Derejko P, Hasiec A, Bardyszewski A, Kuśnierz J, Dzwonkowska D, Szumowski Ł, Orczykowski M, Bodalski R, Baran J, Gorlo A. Distances between transseptal puncture site and anatomical landmarks. J Cardiovasc Electrophysiol 2019; 30:2841-2848. [PMID: 31596023 DOI: 10.1111/jce.14224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/27/2019] [Accepted: 10/05/2019] [Indexed: 11/28/2022]
Abstract
The aim of the study was to provide quantitative data and to look for new landmarks useful during transseptal puncture (TSP) using a fluoroscopy-guided approach. METHODS AND RESULTS: A total of 104 patients at mean age 57 ± 12 years, of whom 92% underwent pulmonary vein isolation, were analysed. Before TSP catheters were placed in the coronary sinus (CS) and His bundle region. A guidewire running from femoral vein through great veins was left loose in superior vena cava. Before TSP X-ray images were taken in right anterior oblique (RAO) 45° and RAO 53° projections. Locations posterior to TSP site in RAO were described with negative values and those anterior with positive values. The measured distances in millimeters were as follows: (a) between TSP site and posterior atrial wall (RAO 45 = -21 ± 7 mm; RAO 53 = -19 ± 6 mm (b) between TSP site and free guidewire (RAO 45 = -5 ± 4 mm, RAO 53 = -3 ± 4 mm (c) between TSP site and CS ostium (RAO 45 = 9 ± 6 mm; RAO 53 = 8 ± 5 mm (d) between TSP site and His region (RAO 45 = 29 ± 8 mm; RAO 53 = 30 ± 8 mm). We observed correlations between measured distances and age, body mass index and sizes of cardiac chambers. The distance between TSP site and the line projected by the guidewire running between great veins, measured in mid-RAO projections, was very small. CONCLUSION: The distances between TSP site and standard anatomical landmarks used during TSP vary with regard to age, physique and cardiac chamber dimensions. TSP site, as assessed in mid RAO, is in direct vicinity to the line projected by a guidewire running between the great veins.
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Affiliation(s)
- Paweł Derejko
- Department of Cardiology and Internal Medicine, Medicover Hospital, Warsaw, Poland
| | - Andrzej Hasiec
- Department of Cardiac Arrhythmias, Institute of Cardiology, Warsaw, Poland
| | | | - Jacek Kuśnierz
- Department of Cardiology and Internal Medicine, Medicover Hospital, Warsaw, Poland
| | | | - Łukasz Szumowski
- Department of Cardiac Arrhythmias, Institute of Cardiology, Warsaw, Poland
| | - Michał Orczykowski
- Department of Cardiac Arrhythmias, Institute of Cardiology, Warsaw, Poland
| | - Robert Bodalski
- Department of Cardiac Arrhythmias, Institute of Cardiology, Warsaw, Poland
| | - Jakub Baran
- Division of Clinical Electrophysiology, Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Adam Gorlo
- Department of Cardiology, The Center of Invasive Cardiology-Scanmed, Ełk, Poland
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15
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Ignacio DM, Jarma DJJ, Nicolas V, Gustavo D, Leandro T, Milagros C, Vasquez E, Alberto G, Santiago R, Gaston A, Fernando S. Current Safety of Pulmonary Vein Isolation in Paroxysmal Atrial Fibrillation: First Experience of Same Day Discharge. J Atr Fibrillation 2018; 11:2077. [PMID: 31139283 DOI: 10.4022/jafib.2077] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 08/19/2017] [Accepted: 08/09/2018] [Indexed: 11/10/2022]
Abstract
Introduction Pulmonary vein isolation (PVI) has become the standard treatment of symptomatic atrial fibrillation. Patients remain hospitalized for at least 24 hours to detect potential complications in most centers worldwide. There is still a lack of data about the safety of same-day discharge. Objectives The aim was to compare the safety of same-day discharge with next day discharge after overnight monitoring.The rate of new hospitalization and visits to the emergency department and the costeffectiveness of the same-day discharge approach were evaluated. Methods We conducted a longitudinal and prospective cohort study of all the consecutive patients undergoing scheduled pulmonary vein ablation of either paroxysmal or persistent atrial fibrillation (AF). The complications were recorded by type and time of occurrence. Results Overall 58 patients were discharged within the same day and 137 patients stayed overnight after PVI. There were no significant differences in demography, comorbidities and other predictors of complications. No complications were reported after the sixth hour. We observed a significant difference in the number of visits to emergency department: 15.5% for the same-day discharge group vs. 30.7% for the overnight hospitalization group (p 0.03). Only 50% of the reasons to visit the emergency department were cardiovascular causes. No cases of pericardial tamponade were reported and none of the patients required new hospitalization up to 30 days of follow up. Conclusions Same-day discharge after PVI is feasible and cost-effective. This is the first study analyzing the experience in patients undergoing AVP,considering acare based component to this procedure. This approach would provide significant benefits for patients and health care providers.
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Affiliation(s)
| | | | | | | | - Tomas Leandro
- Instituto Cardiovascular de Buenos Aires, Electrophysiology
| | - Caro Milagros
- Instituto Cardiovascular de Buenos Aires, Electrophysiology
| | - Elias Vasquez
- Instituto Cardiovascular de Buenos Aires, Electrophysiology
| | | | | | - Albina Gaston
- Instituto Cardiovascular de Buenos Aires, Electrophysiology
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16
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Lee WC, Tsai TH, Huang CF, Wu CJ. Successful rescue with transcatheter repair for aortic iatrogenic perforation during transseptal puncture. J Interv Card Electrophysiol 2018; 55:121-123. [PMID: 30374658 DOI: 10.1007/s10840-018-0472-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 10/11/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Wei-Chieh Lee
- Division of Cardiology, Department of Internal Medicine, Chang Gung University College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, No. 123, Ta Pei Rd, Niao-Sung district, Kaohsiung City, 83301, Taiwan.
| | - Tzu-Hsien Tsai
- Division of Cardiology, Department of Internal Medicine, Chang Gung University College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chien-Fu Huang
- Division of Cardiology, Department of Pediatrics, Chang Gung University College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chiung-Jen Wu
- Division of Cardiology, Department of Internal Medicine, Chang Gung University College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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17
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Manolis AS. Transseptal Access to the Left Atrium: Tips and Tricks to Keep it Safe Derived from Single Operator Experience and Review of the Literature. Curr Cardiol Rev 2018; 13:305-318. [PMID: 28969539 PMCID: PMC5730964 DOI: 10.2174/1573403x13666170927122036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 09/13/2017] [Accepted: 09/20/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Transseptal puncture (TSP) remains a demanding procedural step in accessing the left atrium with inherent risks and safety concerns, mostly related to cardiac tamponade. OBJECTIVE Based on our own experience with 249 TSP procedures and in-depth literature review, we present our results and offer several tips and tricks that may render TSP successful and safe. METHODS This prospective study comprised 249 consecutive patients (146 men), aged 41.6±17.4 years, undergoing TSP by a single operator for ablation of a variety of arrhythmias, mostly related to left accessory pathways (n=145) or left atrial tachycardias (n=33) and more recently, atrial fibrillation (n=70). TSP was guided by fluoroscopy alone in all patients without the use of echocardiography imaging. In addition, an extensive literature review of TSP-related topics was carried out in PubMed, Scopus and Google Scholar. RESULTS Among 249 patients, 33 patients were children or young adolescents (aged 7-18 years); 14 patients were undergoing a repeat procedure. Patients with a manifest accessory pathway were the youngest (mean age 33.7±15.9) and patients with atrial fibrillation the oldest (mean age 56.0±10.8 years). A successful TSP was accomplished in 247 patients (99.2%). Two (0.8%) procedures were complicated by cardiac tamponade managed successfully with pericardiocentesis or surgical drainage. Review of the literature revealed no systematic reviews and meta-analyses of TSP studies; however, several patient series have documented that fluoroscopy-guided TSP, with various modifications in the technique employed in the present series, have been effective in 95-100% of the cases with a complication rate ranging from 0.0% to 6.7%, albeit with a mortality rate of 0.018%- 0.2%. Echo imaging techniques were employed in cases with difficult TSP. CONCLUSION Employing a standardized protocol with use of fluoroscopy alone minimized serious complications to 0.8% (2 patients) among 249 consecutive patients undergoing TSP for ablation of a variety of cardiac arrhythmias. Based on this single-operator experience and review of the literature, a list of practical tips and tricks is provided for a successful and safe procedure, reserving the more expensive and patient inconveniencing echo-imaging techniques for difficult or failed cases.
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Affiliation(s)
- Antonis S Manolis
- Third Department of Cardiology, Vas. Sofias 114, Athens 115 27. Greece
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18
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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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19
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Alkhouli M, Rihal CS, Holmes DR. Transseptal Techniques for Emerging Structural Heart Interventions. JACC Cardiovasc Interv 2017; 9:2465-2480. [PMID: 28007198 DOI: 10.1016/j.jcin.2016.10.035] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 09/25/2016] [Accepted: 10/06/2016] [Indexed: 12/18/2022]
Abstract
The development of new transseptal transcatheter interventions for patients with structural heart disease is fueling increasing interest in transseptal puncture techniques. The authors review contemporary transseptal puncture indications and techniques and provide a step-by-step approach to challenging transseptal access and procedural complications.
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Affiliation(s)
- Mohamad Alkhouli
- Divisions of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Charanjit S Rihal
- Divisions of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - David R Holmes
- Divisions of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.
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20
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Basman C, Parmar YJ, Kronzon I. Intracardiac Echocardiography for Structural Heart and Electrophysiological Interventions. Curr Cardiol Rep 2017; 19:102. [PMID: 28879526 DOI: 10.1007/s11886-017-0902-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW With an increasing number of interventional procedures performed for structural heart disease and cardiac arrhythmias each year, echocardiographic guidance is necessary for safe and efficient results. The purpose of this review article is to overview the principles of intracardiac echocardiography (ICE) and describes the peri-interventional role of ICE in a variety of structural heart disease and electrophysiological interventions. RECENT FINDINGS Both transthoracic (TTE) and transesophageal echocardiography have limitations. ICE provides the advantage of imaging from within the heart, providing shorter image distances and higher resolution. ICE may be performed without sedation and avoids esophageal intubation as with transesophageal echocardiography (TEE). Limitations of ICE include the need for additional venous access with possibility of vascular complications, potentially higher costs, and a learning curve for new operators. Data supports the use of ICE in guiding device closure of interatrial shunts, transseptal puncture, and electrophysiologic procedures. This paper reviews the more recent reports that ICE may be used for primary guidance or as a supplement to TEE in patients undergoing left atrial appendage (LAA) closure, interatrial shunt closure, transaortic valve implantation (TAVI), percutaneous mitral valve repair (PMVR), paravalvular leak (PVL) closure, aortic interventions, transcatheter pulmonary valve replacement (tPVR), ventricular septal defect (VSD), and patent ductus arteriosus (PDA) closure. ICE imaging technology will continue to expand and help improve structural heart and electrophysiology interventions.
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Affiliation(s)
- Craig Basman
- Department of Cardiovascular Medicine, Lenox Hill Hospital - Northwell Health, New York, NY, USA
| | - Yuvrajsinh J Parmar
- Department of Cardiovascular Medicine, Lenox Hill Hospital - Northwell Health, New York, NY, USA
| | - Itzhak Kronzon
- Department of Cardiovascular Medicine, Lenox Hill Hospital - Northwell Health, New York, NY, USA.
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21
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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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22
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Koektuerk B, Yorgun H, Koektuerk O, Turan CH, Gorr E, Horlitz M, Turan RG. Rotational Angiography Based Three-Dimensional Left Atrial Reconstruction: A New Approach for Transseptal Puncture. Cardiovasc Ther 2016; 34:49-56. [PMID: 26607305 DOI: 10.1111/1755-5922.12167] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AIM 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 ± 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 ± 825.3 μGym(2). The mean time beginning from femoral vein puncture to TSP was 12.3 ± 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.
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Affiliation(s)
- Buelent Koektuerk
- Department of Cardiology/Electrophysiology, Witten/Herdecke University, Krankenhaus Porz am Rhein, Cologne, Germany
| | - Hikmet Yorgun
- Department of Cardiology/Electrophysiology, Witten/Herdecke University, Krankenhaus Porz am Rhein, Cologne, Germany
| | - Oezlem Koektuerk
- Department of Cardiology/Electrophysiology, Witten/Herdecke University, Krankenhaus Porz am Rhein, Cologne, Germany
| | - Cem H Turan
- Department of Cardiology/Electrophysiology, Witten/Herdecke University, Krankenhaus Porz am Rhein, Cologne, Germany
| | - Eduard Gorr
- Department of Cardiology/Electrophysiology, Witten/Herdecke University, Krankenhaus Porz am Rhein, Cologne, Germany
| | - Marc Horlitz
- Department of Cardiology/Electrophysiology, Witten/Herdecke University, Krankenhaus Porz am Rhein, Cologne, Germany
| | - Ramazan G Turan
- Department of Cardiology/Electrophysiology, Witten/Herdecke University, Krankenhaus Porz am Rhein, Cologne, Germany.,Division of Cardiology, Department of Internal Medicine, University Hospital of Rostock, Rostock, Germany
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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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Affiliation(s)
- George Joseph
- Department of Cardiology, Christian Medical College, Vellore, India
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25
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von Alvensleben JC, Dick M, Bradley DJ, LaPage MJ. Transseptal access in pediatric and congenital electrophysiology procedures: defining risk. J Interv Card Electrophysiol 2014; 41:273-7. [PMID: 25416565 DOI: 10.1007/s10840-014-9946-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 08/26/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE Transseptal puncture (TSP) is commonly used to access the left heart for catheter ablation procedures. The specific complication risk of this procedure has not been determined. This study assesses the risk of TSP using a single standard technique during electrophysiology study (EPS) in pediatrics and congenital heart disease (CHD). METHODS Retrospective cohort study of patients undergoing TSP during EPS at the University of Michigan Congenital Heart Center between 1999 and 2011. RESULTS There were 373 left heart ablation procedures during the study period. Excluded were six adults without CHD, five procedures using an alternative imaging modality, five procedures using retrograde aortic access, one transhepatic access, and one where TSP was performed during a prior procedure. Included were 321 pediatric (≤18 years old without CHD) TSP procedures (median age 13 years) and 34 TSP procedures in patients with CHD (median age 28 years). There was one complication directly attributable to TSP: needle perforation of the left atrium without development of effusion in the pediatric group. Post-procedure echocardiograms were performed in 351 (99 %) cases, showing only trivial effusions in seven (1.9 %). CONCLUSIONS This single center experience over 12 years shows the risk of TSP in pediatric and CHD patients to be low, with a 0.3 % (95 % confidence interval (CI) 0, 0.9 %) risk for complications directly related to TSP using only single plane fluoroscopy for visualization.
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Akca F, Janse P, Theuns DAMJ, Szili-Torok T. A prospective study on safety of catheter ablation procedures: contact force guided ablation could reduce the risk of cardiac perforation. Int J Cardiol 2014; 179:441-8. [PMID: 25465303 DOI: 10.1016/j.ijcard.2014.11.105] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 10/09/2014] [Accepted: 11/05/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Contact force (CF) sensing catheters provide advantages with regard to safety and efficacy. This study aimed to evaluate if CF catheters reduce cardiac perforations and other major complications and offer equal safety compared to the magnetic navigation system (MNS). METHODS Data from 1.517 ablation procedures from our prospective registry was analyzed. Ablations were performed using either CF guided catheters (CF group, n=248), non-CF catheters (NCF group, n=813), or MNS (n=456). Four subgroups were analyzed: atrial fibrillation (AF, n=557), supraventricular tachycardia (SVT, n=715), ventricular tachycardia (VT, n=190) and patients with congenital heart defects (CHD, n=55). The primary endpoint of this study was incidence of cardiac perforation. Secondary endpoints were major and minor complications within 30 days of the procedure. RESULTS Complications occurred in 11.3% (n=172) of the procedures. In 2.8% (n=43) a major complication occurred, 0.9% (n=13) had a perforation, 8.5% (n=129) had a minor complication and 2 patients died (0.1%). No cardiac perforation occurred in the CF group, which was significantly different from NCF procedures (0.0% vs. 1.6%; relative risk 0.76, 95% CI 0.74-0.79, P=0.031) and equal to MNS (0.0%). This was also observed in the AF subgroup (0.0% vs. 3.3%; RR 0.67, 95% CI 0.63-0.72, P=0.021), and the occurrence of major complications was lower for CF versus NCF procedures (2.1% vs. 7.8%, P=0.010). CONCLUSIONS CF-guided catheter ablation is superior to NCF with regard to procedural safety and avoidance of cardiac perforation. This difference is due to a reduction of cardiac perforation and major complications in the AF subgroup.
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Affiliation(s)
- Ferdi Akca
- Department of Clinical Electrophysiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Petter Janse
- Department of Clinical Electrophysiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Dominic A M J Theuns
- Department of Clinical Electrophysiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Tamas Szili-Torok
- Department of Clinical Electrophysiology, Erasmus Medical Center, Rotterdam, The Netherlands.
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Guler E, Babur Guler G, Demir GG, Kizilirmak F, Gunes HM, Barutcu İ, Turkmen MM, Kilicaslan F. Evaluation of Adult versus Pediatric Transesophageal Echocardiography Probe Efficiency for Guiding Septal Puncture during Atrial Fibrillation Ablation. Echocardiography 2014; 32:1109-14. [DOI: 10.1111/echo.12821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Ekrem Guler
- Department of Cardiology; Faculty of Medicine; Medipol University Hospital; Istanbul Turkey
| | - Gamze Babur Guler
- Department of Cardiology; Faculty of Medicine; Medipol University Hospital; Istanbul Turkey
| | - Gultekin Gunhan Demir
- Department of Cardiology; Faculty of Medicine; Medipol University Hospital; Istanbul Turkey
| | - Filiz Kizilirmak
- Department of Cardiology; Faculty of Medicine; Medipol University Hospital; Istanbul Turkey
| | - Hacı Murat Gunes
- Department of Cardiology; Faculty of Medicine; Medipol University Hospital; Istanbul Turkey
| | - İrfan Barutcu
- Department of Cardiology; Faculty of Medicine; Medipol University Hospital; Istanbul Turkey
| | - Mehmet Muhsin Turkmen
- Department of Cardiology; Faculty of Medicine; Medipol University Hospital; Istanbul Turkey
| | - Fethi Kilicaslan
- Department of Cardiology; Faculty of Medicine; Medipol University Hospital; Istanbul Turkey
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LEHRMANN HEIKO, SCHNEIDER JENS, JADIDI AMIRS, PARK CHANIL, SCHIEBELING-RÖMER JOCHEN, ALLGEIER JÜRGEN, ARENTZ THOMAS, WEBER REINHOLD. Transseptal Access for Left Atrial Ablation: The Catheter-Probing Techniques Are Not Without Risk. J Cardiovasc Electrophysiol 2014; 25:479-484. [DOI: 10.1111/jce.12356] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 12/13/2013] [Accepted: 12/23/2013] [Indexed: 11/29/2022]
Affiliation(s)
| | - JENS SCHNEIDER
- Echocardiography Department; University Heart Center Freiburg/Bad Krozingen; Bad Krozingen Germany
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Yao Y, Ding L, Chen W, Guo J, Bao J, Shi R, Huang W, Zhang S, Wong T. The training and learning process of transseptal puncture using a modified technique. Europace 2013; 15:1784-90. [DOI: 10.1093/europace/eut078] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Schernthaner C, Danmayr F, Daburger A, Eichinger J, Hammerer M, Strohmer B. High Incidence of Echocardiographic Abnormalities of the Interatrial Septum in Patients Undergoing Ablation for Atrial Fibrillation. Echocardiography 2012; 30:402-6. [DOI: 10.1111/echo.12067] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Christiana Schernthaner
- Department of Cardiology; Paracelsus Private Medical University; Salzburger Landeskliniken; Salzburg; Austria
| | - Franz Danmayr
- Department of Cardiology; Paracelsus Private Medical University; Salzburger Landeskliniken; Salzburg; Austria
| | - Apollonia Daburger
- Department of Cardiology; Paracelsus Private Medical University; Salzburger Landeskliniken; Salzburg; Austria
| | - Jörg Eichinger
- Department of Cardiology; Paracelsus Private Medical University; Salzburger Landeskliniken; Salzburg; Austria
| | - Matthias Hammerer
- Department of Cardiology; Paracelsus Private Medical University; Salzburger Landeskliniken; Salzburg; Austria
| | - Bernhard Strohmer
- Department of Cardiology; Paracelsus Private Medical University; Salzburger Landeskliniken; Salzburg; Austria
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31
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De Ponti R. Transseptal catheterization: a matter of technology, training, or both? Europace 2012; 14:615-616. [DOI: 10.1093/europace/eus007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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