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Guan F, Gass M, Berger F, Akdis D, Duru F, Wolber T. Transseptal Puncture Guided by Three-Dimensional Electroanatomical Mapping: Early Experience Using a Simplified Approach in Adults with Congenital Heart Disease. J Clin Med 2023; 12:4491. [PMID: 37445531 DOI: 10.3390/jcm12134491] [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: 06/04/2023] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
AIMS The widespread use of three-dimensional (3D) mapping systems and echocardiography in the field of cardiac electrophysiology has made it possible to perform transseptal punctures (TSP) with low or no fluoroscopy. However, such attempts in adults with congenital heart disease (ACHD) who have previously undergone surgical or interventional treatment are limited. Therefore, we sought to explore the feasibility and safety of an approach to perform zero- or low-fluoroscopy TSP in ACHD patients undergoing left atrial cardiac ablation procedures. METHODS AND RESULTS This study included 45 ACHD patients who underwent TSP for ablation of left-sided tachycardias (left atrium or pulmonary venous atrium). Computed tomography (CT) of the heart was performed in all patients prior to ablation. 3D mapping of the right-sided heart chambers before TSP was used to superimpose the registered anatomy, which was subsequently used for the mapping-guided TSP technique. TSP was performed with zero-fluoroscopy in 27 patients, and the remaining 18 patients had a mean fluoroscopy exposure of 315.88 ± 598.43 μGy.m2 and a mean fluoroscopy duration of 1.9 ± 5.4 min. No patient in this cohort experienced TSP-related complications. CONCLUSION Our study describes a fluoroscopy-free or low-dose fluoroscopy approach for TSP in ACHD patients undergoing catheter ablation of left-sided tachyarrhythmias who had been previously treated surgically or interventionally due to congenital heart defects. By superimposing 3D electroanatomic mapping with cardiac CT anatomy, this protocol proved to be highly effective, feasible and safe.
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Affiliation(s)
- Fu Guan
- Department of Cardiology, Arrhythmia and Electrophysiology Division, University Heart Center Zurich, 8091 Zurich, Switzerland
| | - Matthias Gass
- Children's Research Center, Zurich University Children's Hospital, 8032 Zurich, Switzerland
| | - Florian Berger
- Children's Research Center, Zurich University Children's Hospital, 8032 Zurich, Switzerland
| | - Deniz Akdis
- Department of Cardiology, Arrhythmia and Electrophysiology Division, University Heart Center Zurich, 8091 Zurich, Switzerland
| | - Firat Duru
- Department of Cardiology, Arrhythmia and Electrophysiology Division, University Heart Center Zurich, 8091 Zurich, Switzerland
- Center for Integrative Human Physiology, University of Zurich, 8091 Zurich, Switzerland
| | - Thomas Wolber
- Department of Cardiology, Arrhythmia and Electrophysiology Division, University Heart Center Zurich, 8091 Zurich, Switzerland
- Center for Integrative Human Physiology, University of Zurich, 8091 Zurich, Switzerland
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Kisling AJ, Symons JG, Daubert JP. Catheter ablation of atrial fibrillation: anticipating and avoiding complications. Expert Rev Med Devices 2023; 20:929-941. [PMID: 37691572 DOI: 10.1080/17434440.2023.2257131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/06/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION Atrial fibrillation (AF) ablation is being performed more frequently and more widely at more centers. This stems from several factors including 1) demographic forces leading to an increased prevalence of the arrhythmia; 2) greater availability of ambulatory monitoring making diagnosis more frequent; 3) relative inefficacy of medications; and 4) improved safety and efficacy of the procedure. Ablation has become much more streamlined and reproducible than a decade ago, but life-threatening complications may still arise. AREAS COVERED This review will focus on awareness, avoidance, and early recognition and management of complications of AF ablation. This literature review is challenged by differing approaches to ablation of AF both within a center and between centers, the rapid improvement of technology making the outcomes associated with a therapeutic strategy begun a few years prior relatively obsolete, as well as the heterogeneity of the population being studied. EXPERT OPINION Newer technologies are on the horizon which will allow us to ablate AF with increasing efficacy, efficiency, and hopefully safety. Such new technology and changing usage mandate vigilance to avoid complications.
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Affiliation(s)
- Adam J Kisling
- Walter Reed National Military Medical Center, Department of Cardiology, Bethesda, MD, United States of America
| | - John G Symons
- Walter Reed National Military Medical Center, Department of Electrophysiology, Bethesda, MD, United States of America
| | - James P Daubert
- Electrophysiology Section/Duke Center for Atrial Fibrillation, Division of Cardiology, Duke Clinical Research Institute, Department of Medicine, Duke University, Durham, NC, United States of America
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Chokesuwattanaskul R, Ananwattanasuk T, Hughey AB, Stuart EA, Shah MM, Atreya AR, Chugh A, Bogun F, Crawford T, Pelosi F, Cunnane R, Ghanbari H, Latchamsetty R, Chung E, Saeed M, Ghannam M, Liang J, Oral H, Morady F, Jongnarangsin K. Three-dimensional-guided and ICE-guided transseptal puncture for cardiac ablations: A propensity score match study. J Cardiovasc Electrophysiol 2023; 34:382-388. [PMID: 36423239 PMCID: PMC10108269 DOI: 10.1111/jce.15756] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 10/05/2022] [Accepted: 10/20/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Transseptal puncture (TSP) is routinely performed for left atrial ablation procedures. The use of a three-dimensional (3D) mapping system or intracardiac echocardiography (ICE) is useful in localizing the fossa ovalis and reducing fluoroscopy use. We aimed to compare the safety and efficacy between 3D mapping system-guided TSP and ICE-guided TSP techniques. METHODS We conducted a prospective observational study of patients undergoing TSP for left atrial catheter ablation procedures (mostly atrial fibrillation ablation). Propensity scoring was used to match patients undergoing 3D-guided TSP with patients undergoing ICE-guided TSP. Logistic regression was used to compare the clinical data, procedural data, fluoroscopy time, success rate, and complications between the groups. RESULTS Sixty-five patients underwent 3D-guided TSP, and 151 propensity score-matched patients underwent ICE-guided TSP. The TSP success rate was 100% in both the 3D-guided and ICE-guided groups. Median needle time was 4.00 min (interquartile range [IQR]: 2.57-5.08) in patients with 3D-guided TSP compared to 4.02 min (IQR: 2.83-6.95) in those with ICE-guided TSP (p = .22). Mean fluoroscopy time was 0.2 min (IQR: 0.1-0.4) in patients with 3D-guided TSP compared to 1.2 min (IQR: 0.7-2.2) in those with ICE-guided TSP (p < .001). There were no complications related to TSP in both group. CONCLUSIONS Three-dimensional mapping-guided TSP is as safe and effective as ICE-guided TSP without additional cost.
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Affiliation(s)
- Ronpichai Chokesuwattanaskul
- Cardiovascular Medicine Department, Center of Excellence in Arrhythmia Research, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand.,Division of Cardiac Electrophysiology, University of Michigan Health Care, Ann Arbor, Michigan, USA
| | - Teetouch Ananwattanasuk
- Division of Cardiac Electrophysiology, University of Michigan Health Care, Ann Arbor, Michigan, USA.,Department of Internal Medicine, Cardiology Division, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | | | - Elizabeth A Stuart
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Muazzum M Shah
- Division of Cardiac Electrophysiology, University of Michigan Health Care, Ann Arbor, Michigan, USA
| | - Auras R Atreya
- Section of Cardiac Electrophysiology, AIG Institute of Cardiac Sciences and Research, Hyderabad, India
| | - Aman Chugh
- Division of Cardiac Electrophysiology, University of Michigan Health Care, Ann Arbor, Michigan, USA
| | - Frank Bogun
- Division of Cardiac Electrophysiology, University of Michigan Health Care, Ann Arbor, Michigan, USA
| | - Thomas Crawford
- Division of Cardiac Electrophysiology, University of Michigan Health Care, Ann Arbor, Michigan, USA
| | - Frank Pelosi
- Division of Cardiac Electrophysiology, University of Michigan Health Care, Ann Arbor, Michigan, USA
| | - Ryan Cunnane
- Division of Cardiac Electrophysiology, University of Michigan Health Care, Ann Arbor, Michigan, USA
| | - Hamid Ghanbari
- Division of Cardiac Electrophysiology, University of Michigan Health Care, Ann Arbor, Michigan, USA
| | - Rakesh Latchamsetty
- Division of Cardiac Electrophysiology, University of Michigan Health Care, Ann Arbor, Michigan, USA
| | - Eugene Chung
- Division of Cardiac Electrophysiology, University of Michigan Health Care, Ann Arbor, Michigan, USA
| | - Mohammed Saeed
- Division of Cardiac Electrophysiology, University of Michigan Health Care, Ann Arbor, Michigan, USA
| | - Michael Ghannam
- Division of Cardiac Electrophysiology, University of Michigan Health Care, Ann Arbor, Michigan, USA
| | - Jackson Liang
- Division of Cardiac Electrophysiology, University of Michigan Health Care, Ann Arbor, Michigan, USA
| | - Hakan Oral
- Division of Cardiac Electrophysiology, University of Michigan Health Care, Ann Arbor, Michigan, USA
| | - Fred Morady
- Division of Cardiac Electrophysiology, University of Michigan Health Care, Ann Arbor, Michigan, USA
| | - Krit Jongnarangsin
- Division of Cardiac Electrophysiology, University of Michigan Health Care, Ann Arbor, Michigan, USA
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Transseptal puncture during catheter ablation associated with higher radiation exposure. Cardiol Young 2022; 33:754-759. [PMID: 35673794 DOI: 10.1017/s1047951122001676] [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] [Indexed: 11/07/2022]
Abstract
BACKGROUND Electroanatomic mapping systems are increasingly used during ablations to decrease the need for fluoroscopy and therefore radiation exposure. For left-sided arrhythmias, transseptal puncture is a common procedure performed to gain access to the left side of the heart. We aimed to demonstrate the radiation exposure associated with transseptal puncture. METHODS Data were retrospectively collected from the Catheter Ablation with Reduction or Elimination of Fluoroscopy registry. Patients with left-sided accessory pathway-mediated tachycardia, with a structurally normal heart, who had a transseptal puncture, and were under 22 years of age were included. Those with previous ablations, concurrent diagnostic or interventional catheterisation, and missing data for fluoroscopy use or procedural outcomes were excluded. Patients with a patent foramen ovale who did not have a transseptal puncture were selected as the control group using the same criteria. Procedural outcomes were compared between the two groups. RESULTS There were 284 patients in the transseptal puncture group and 70 in the patent foramen ovale group. The transseptal puncture group had a significantly higher mean procedure time (158.8 versus 131.4 minutes, p = 0.002), rate of fluoroscopy use (38% versus 7%, p < 0.001), and mean fluoroscopy time (2.4 versus 0.6 minutes, p < 0.001). The acute success and complication rates were similar. CONCLUSIONS Performing transseptal puncture remains a common reason to utilise fluoroscopy in the era of non-fluoroscopic ablation. Better tools are needed to make non-fluoroscopic transseptal puncture more feasible.
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Fluoroless left atrial access for radiofrequency and cryoballoon ablations using a novel radiofrequency transseptal wire. J Interv Card Electrophysiol 2022; 64:183-190. [PMID: 35194727 PMCID: PMC9236982 DOI: 10.1007/s10840-022-01157-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/09/2022] [Indexed: 12/27/2022]
Abstract
Purpose Conventional catheter ablation for atrial fibrillation requires fluoroscopy, which has inherent risks of radiation exposure to patients and medical staff. Optimization of fluoroscopy parameters and use of three-dimensional electroanatomic mapping (EAM) and intracardiac echocardiography (ICE) have helped to reduce radiation exposure; however, despite growing evidence, there are still concerns about safety and added procedure time associated with fluoroless procedures, particularly in left-sided ablations, due to the potential risk of complications. Herein, we report our initial experience using a radiofrequency (RF) wire for completely fluoroless radiofrequency ablation (RFA) and cryoballoon ablation (CBA). Methods A retrospective analysis was conducted on ablation procedures for various cardiac arrhythmias performed non-fluoroscopically at two centers using the VersaCross RF wire transseptal system under EAM and ICE guidance. Results A total of 72 and 54 patients underwent RFA and CBA, respectively, successfully without any procedural complications. Transseptal access time for RFA was 14.5 ± 6.6 min from procedure start (including sheath and catheter placements ± right-sided ablation) or 2.8 ± 1.0 min from RF wire insertion into the femoral introducer. Transseptal access time for CBA was 19.2 ± 11.7 min from procedure start (including sheath and catheter placements ± right-sided ablation) or 3.5 ± 1.6 min from RF wire insertion into the femoral introducer. Average procedure time was 104.4 ± 38.0 min for RFA and 91.1 ± 22.1 min for CBA. Conclusions A RF wire can be used to achieve completely fluoroless transseptal puncture safely and effectively while improving procedural efficiency in both RFA and CBA.
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Eichenlaub M, Weber R, Minners J, Allgeier HJ, Jadidi A, Müller-Edenborn B, Neumann FJ, Arentz T, Lehrmann H. 3D mapping for the identification of the fossa ovalis in left atrial ablation procedures: a pilot study of a first step towards an electroanatomic-guided transseptal puncture. Europace 2021; 22:732-738. [PMID: 32142124 DOI: 10.1093/europace/euaa034] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 01/27/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS Transseptal puncture (TP) for left atrial (LA) catheter ablation procedures is routinely performed under fluoroscopic guidance. To decrease radiation exposure and increase safety alternative techniques are desirable. The aim of this study was to assess whether right atrial (RA) electroanatomic 3D mapping can reliably identify the fossa ovalis (FO) in preparation of TP. METHODS AND RESULTS Between May 2019 and August 2019, electroanatomic RA mapping was performed before TP in 61 patients with paroxysmal or persistent atrial fibrillation. Three electroanatomic methods for FO identification, mapping catheter-induced FO protrusion, electroanatomic-guided analysis, and voltage mapping, were evaluated and compared with transoesophageal echocardiography (TOE). Mapping catheter-induced FO protrusion was feasible in 60 patients (98%) with a mean displacement of 6.8 ± 2.5 mm, confirmed by TOE, and proofed to be the most valuable and easiest marker for FO identification. Electroanatomic-guided analysis localized the FO midpoint consistently in the lower half (43 ± 7%) and posterior (18.2 ± 4.4 mm) to a line between coronary sinus and vena cava superior. Analysis of RA voltage maps during sinus rhythm (n = 40, low-voltage cut-off value 1.0 and 1.5 mV) allowed secure FO recognition in 33% and 18%, only. A step-by-step approach, combining FO protrusion (first step) with anatomy criteria in case of protrusion failure (second step) would have allowed for the correct localization of a TP site within the FO in all patients. CONCLUSION Right atrial electroanatomic 3D mapping prior to TP proofed to be a simple tool for FO identification and may potentially be of use in the safe and radiation-free performance of TP prior to LA ablation procedures.
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Affiliation(s)
- Martin Eichenlaub
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Suedring 15, 79189 Bad Krozingen, Germany
| | - Reinhold Weber
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Suedring 15, 79189 Bad Krozingen, Germany
| | - Jan Minners
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Suedring 15, 79189 Bad Krozingen, Germany
| | - Hans-Jürgen Allgeier
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Suedring 15, 79189 Bad Krozingen, Germany
| | - Amir Jadidi
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Suedring 15, 79189 Bad Krozingen, Germany
| | - Björn Müller-Edenborn
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Suedring 15, 79189 Bad Krozingen, Germany
| | - Franz-Josef Neumann
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Suedring 15, 79189 Bad Krozingen, Germany
| | - Thomas Arentz
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Suedring 15, 79189 Bad Krozingen, Germany
| | - Heiko Lehrmann
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Suedring 15, 79189 Bad Krozingen, Germany
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Troisi F, Quadrini F, Di Monaco A, Vitulano N, Caruso R, Guida P, Langialonga T, Grimaldi M. Electroanatomic guidance versus conventional fluoroscopy during transseptal puncture for atrial fibrillation ablation. J Cardiovasc Electrophysiol 2020; 31:2607-2613. [PMID: 32700436 DOI: 10.1111/jce.14683] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 06/23/2020] [Accepted: 07/06/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Technological advancement in the setting of atrial fibrillation (AF) ablation has decreased radiation exposure and complications associated with the procedure. Yet, transseptal puncture (TSP) remains a challenging step that necessitates accurate guidance. We describe our experience performing TSP under electroanatomic (EA) guidance. METHODS AND RESULTS The analysis included 145 consecutive EA-guided ablation procedures performed between June 2018 and April 2019 and 145 consecutive standard ablations performed before June 2018. EA guidance utilized the CARTO 3 three-dimensional mapping system to reconstruct anatomic and electrical characteristics of the right atrium and fossa ovalis. Patients with a history of previous cardiac surgery were excluded. For EA-guided procedures, the mean patient age was 60 ± 10 years, 75.2% were male, and 69.0% had paroxysmal AF. Similarly, the mean age for conventional procedures was 60 ± 11 years, 71.0% were male, and 71.7% had paroxysmal AF. The fossa ovalis was detected as a region of low voltage, <0.75 mV. EA guidance yielded shorter fluoroscopy times (EA vs. conventional, 3.6 ± 2.5 vs. 13.5 ± 10.5 min; p < .001) and a lower dose area product than conventional guidance (13 ± 11 Gy* cm2 vs. 28 ± 27 Gy* cm2 ; p < .001). The total procedure duration was similar between groups (146 ± 48 vs. 148 ± 54 min). There were no significant complications related to TSP. CONCLUSION During AF ablation, TSP with EA guidance facilitated safe access to the left atrium while reducing radiation risk to both patients and operators.
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Affiliation(s)
- Federica Troisi
- Cardiology Department, Regional General Hospital "F. Miulli", Acquaviva delle Fonti, Italy
| | - Federico Quadrini
- Cardiology Department, Regional General Hospital "F. Miulli", Acquaviva delle Fonti, Italy
| | - Antonio Di Monaco
- Cardiology Department, Regional General Hospital "F. Miulli", Acquaviva delle Fonti, Italy
| | - Nicola Vitulano
- Cardiology Department, Regional General Hospital "F. Miulli", Acquaviva delle Fonti, Italy
| | - Rosa Caruso
- Cardiology Department, Regional General Hospital "F. Miulli", Acquaviva delle Fonti, Italy
| | - Pietro Guida
- Cardiology Department, Regional General Hospital "F. Miulli", Acquaviva delle Fonti, Italy
| | - Tommaso Langialonga
- Cardiology Department, Regional General Hospital "F. Miulli", Acquaviva delle Fonti, Italy
| | - Massimo Grimaldi
- Cardiology Department, Regional General Hospital "F. Miulli", Acquaviva delle Fonti, Italy
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Salam T, Wilson L, Bohannan S, Morin M. Safety and Effectiveness of a Novel Fluoroless Transseptal Puncture Technique for Lead-free Catheter Ablation: A Case Series. J Innov Card Rhythm Manag 2020; 11:4079-4085. [PMID: 32368383 PMCID: PMC7192152 DOI: 10.19102/icrm.2020.110405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 10/28/2019] [Indexed: 01/07/2023] Open
Abstract
Increasing awareness of the health risks associated with the exposure of patients and staff in the catheterization laboratory to radiation has encouraged the pursuit of efforts to reduce the use of fluoroscopy during catheter ablation procedures. Although nonfluoroscopic guidance of ablation catheters has been previously described, transseptal access is still perceived as the last remaining barrier to completely fluoroless ablations. This study examined the safety and effectiveness of transseptal puncture and radiofrequency (RF) catheter ablation using a completely fluoroless approach. Three hundred eighty-two consecutive cases that had undergone completely nonfluoroscopic RF catheter ablation were evaluated. Ablation procedures were performed for atrial fibrillation, atrial flutter, atrioventricular reentry tachycardia, and pulmonary vein complex/ventricular tachycardia. Transseptal puncture and RF ablation were conducted under three-dimensional electroanatomic mapping and intracardiac echocardiography image guidance. Fluoroless transseptal puncture and catheter ablation were completed successfully in all cases, with no intraoperative complications. One patient required minimal use of fluoroscopy to visualize sheath advancement through an existing inferior vena cava filter. Procedural time was approximately 2.2 hours from transvenous access until case conclusion; transseptal access was obtained within 28 minutes of procedure initiation. Arrhythmia was found to recur in 27% of cases on average three months after the procedure. We demonstrate the safety and effectiveness of a completely fluoroless transseptal puncture and RF ablation technique that eliminates radiation exposure and enables complex electrophysiology procedures to be performed in a lead-free environment.
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Affiliation(s)
- Tariq Salam
- Pulse Heart Institute, MultiCare Health System, Tacoma, WA, USA
| | - Lane Wilson
- Pulse Heart Institute, MultiCare Health System, Tacoma, WA, USA
| | - Sara Bohannan
- Pulse Heart Institute, MultiCare Health System, Tacoma, WA, USA
| | - Michael Morin
- Pulse Heart Institute, MultiCare Health System, Tacoma, WA, USA
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Guo XG, Sun Q, Ouyang F. Searching for fossa ovalis using 3D electroanatomic mapping: look before the jump. Europace 2020; 22:679-680. [PMID: 32206797 DOI: 10.1093/europace/euaa063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Xiao-Gang Guo
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037, Beilishi Road #167, Beijing, China
| | - Qi Sun
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037, Beilishi Road #167, Beijing, China
| | - Feifan Ouyang
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037, Beilishi Road #167, Beijing, China
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Imnadze G, Ajaj T, Bante H, Sohns C, Sommer P. Transseptal puncture without fluoroscopy using a radiofrequency needle: A case series. Cardiol J 2020; 28:655-662. [PMID: 32037502 DOI: 10.5603/cj.a2020.0008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 01/21/2020] [Accepted: 12/24/2019] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The non-fluoroscopy approach with the use of a three-dimensional (3D) navigation system is increasingly recognized as a future technology in the treatment of arrhythmias. However, there are a limited number of articles published concerning transseptal puncture without the use of fluoroscopy. METHODS Presented in this paper is the first series of patients (n = 10) that have undergone transseptal puncture without the use of fluoroscopy under transesophageal echocardiography control using a radiofrequency transseptal needle and a 3D navigation system. RESULTS All patients were treated without complications. In 6 patients, re-pulmonary vein isolation was performed. In 5 cases, linear ablation of the left atrium for treatment of left atrial macro re-entry tachycardia was provided. In 2 patients, focal atrial tachycardia was treated, 1 patient underwent cavo tricuspidal isthmus (CTI) ablation and 1 patient, re-CTI ablation. The ablation of complex fragmented atrial electrograms was done in 2 patients. In 1 case, right atrial macro re-entry tachycardia was treated. CONCLUSIONS Transseptal puncture without using fluoroscopy is safe and effective when using a radiofrequency needle, a 3D navigation system and transesophageal echocardiography.
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Affiliation(s)
- Guram Imnadze
- Arrhythmia Department, Klinikum Osnabrueck, Germany. .,Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.
| | - Tarek Ajaj
- Arrhythmia Department, Klinikum Osnabrueck, Germany
| | | | - Christian Sohns
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
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Baykaner T, Quadros KK, Thosani A, Yasmeh B, Mitra R, Liu E, Belden W, Liu Z, Costea A, Brodt CR, Zei PC. Safety and efficacy of zero fluoroscopy transseptal puncture with different approaches. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 43:12-18. [PMID: 31736095 DOI: 10.1111/pace.13841] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 09/30/2019] [Accepted: 10/08/2019] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Atrial fibrillation (AF) ablation requires access to the left atrium (LA) via transseptal puncture (TP). TP is traditionally performed with fluoroscopic guidance. Use of intracardiac echocardiography (ICE) and three-dimensional mapping allows for zero fluoroscopy TP. OBJECTIVE To demonstrate safety and efficacy of zero fluoroscopy TP using multiple procedural approaches. METHODS Patients undergoing AF ablation between January 2015 and November 2017 at five institutions were included. ICE and three-dimensional mapping were used for sheath positioning and TP. Variable technical approaches were used across centers including placement of J wire in the superior vena cava with ICE guidance followed by dragging down the transseptal sheath into the interatrial septum, or guiding the transseptal sheath directly to the interatrial septum by localizing the ablation catheter with three-dimensional mapping and replacing it with the transseptal needle once in position. In patients with pacemaker/implantable cardiac defibrillator leads, pre-/poststudy device interrogation was performed. RESULTS A total of 747 TPs were performed (646 patients, age 63.1 ± 13.1, 67.5% male, LA volume index 34.5 ± 15.8 mL/m2 , ejection fraction 57.7 ± 10.9%) with 100% success. No punctures required fluoroscopy. Two pericardial effusions, two pericardial tamponades requiring pericardiocentesis, and one transient ischemic attack were observed during the overall ablation procedure, with a total complication rate of 0.7%. There were no other periprocedural complications related to TP, including intrathoracic bleeding, stroke, or death both immediately following TP and within 30 days of the procedure. In patients with intracardiac devices, no device-related complications were observed. CONCLUSION TP can be safely and effectively performed without the need for fluoroscopy.
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Affiliation(s)
- Tina Baykaner
- Department of Medicine, Stanford University, Stanford, California
| | - Kenneth K Quadros
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Amit Thosani
- Cardiovascular Institute, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Babak Yasmeh
- Department of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Raman Mitra
- Department of Medicine, Beacon Health System, South Bend, Indiana
| | - Emerson Liu
- Cardiovascular Institute, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - William Belden
- Cardiovascular Institute, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Zhigang Liu
- Department of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Alex Costea
- Department of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Chad R Brodt
- Department of Medicine, Stanford University, Stanford, California
| | - Paul C Zei
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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