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Chen Y, Wu X, Yang M, Li Z, Zhou R, Lin W, Zheng C, Hu Y, Li J, Li Y, Lin J, Gallagher MM, Li J. Optimizing transseptal puncture guided by three-dimensional mapping: the role of a unipolar electrogram in a needle tip. Europace 2024; 26:euae098. [PMID: 38619048 PMCID: PMC11050654 DOI: 10.1093/europace/euae098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 04/11/2024] [Indexed: 04/16/2024] Open
Abstract
AIMS A three-dimensional electroanatomic mapping system-guided transseptal puncture (3D-TSP), without fluoroscopy or echocardiography, has been only minimally reported. Indications for 3D-TSP remain unclear. Against this background, this study aims to establish a precise technique and create a workflow for validating and selecting eligible patients for fluoroless 3D-TSP. METHODS AND RESULTS We developed a new methodology for 3D-TSP based on a unipolar electrogram derived from a transseptal needle tip (UEGM tip) in 102 patients (the derivation cohort) with intracardiac echocardiography (ICE) from March 2018 to February 2019. The apparent current of injury (COI) was recorded at the muscular limbus of the foramen ovalis (FO) on the UEGM tip (sinus rhythm: 2.57 ± 0.95 mV, atrial fibrillation: 1.92 ± 0.77 mV), which then disappeared or significantly reduced at the central FO. Changes in the COI, serving as a major criterion to establish a 3D-TSP workflow, proved to be the most valuable indicator for identifying the FO in 99% (101/102) of patients compared with three previous techniques (three minor criteria) of reduction in atrial unipolar or bipolar potential and FO protrusion. A total of 99.9% (1042/1043) patients in the validation cohort underwent successful 3D-TSP through the workflow from March 2019 to July 2023. Intracardiac echocardiography guidance was required for 6.6% (69/1042) of patients. All four criteria were met in 740 patients, resulting in a 100% pure fluoroless 3D-TSP success rate. CONCLUSION In most patients, fluoroless 3D-TSP was successfully achieved using changes in the COI on the UEGM tip. Patients who met all four criteria were considered suitable for 3D-TSP, while those who met none required ICE guidance.
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Affiliation(s)
- Yifan Chen
- Department of Cardiology, Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, No.109 Xueyuan West Road, Lucheng District, Wenzhou 325000, Zhejiang, China
| | - Xiaoyan Wu
- Department of Cardiology, Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, No.109 Xueyuan West Road, Lucheng District, Wenzhou 325000, Zhejiang, China
| | - Mengting Yang
- Department of Cardiology, Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, No.109 Xueyuan West Road, Lucheng District, Wenzhou 325000, Zhejiang, China
| | - Zhibin Li
- Department of Cardiology, Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, No.109 Xueyuan West Road, Lucheng District, Wenzhou 325000, Zhejiang, China
| | - Ruya Zhou
- Department of Cardiology, Lishui People’s Hospital, Lishui 323000, China
| | - Weiqian Lin
- Department of Cardiology, Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, No.109 Xueyuan West Road, Lucheng District, Wenzhou 325000, Zhejiang, China
| | - Cheng Zheng
- Department of Cardiology, Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, No.109 Xueyuan West Road, Lucheng District, Wenzhou 325000, Zhejiang, China
| | - Youdong Hu
- Department of Cardiology, Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, No.109 Xueyuan West Road, Lucheng District, Wenzhou 325000, Zhejiang, China
| | - Jin Li
- Department of Cardiology, Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, No.109 Xueyuan West Road, Lucheng District, Wenzhou 325000, Zhejiang, China
| | - Yuechun Li
- Department of Cardiology, Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, No.109 Xueyuan West Road, Lucheng District, Wenzhou 325000, Zhejiang, China
| | - Jiafeng Lin
- Department of Cardiology, Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, No.109 Xueyuan West Road, Lucheng District, Wenzhou 325000, Zhejiang, China
| | - Mark M Gallagher
- Cardiology Clinical Academic Group, St George’s University Hospitals NHS Foundation Trust, Blackshaw Road, London SW17 0QT, UK
| | - Jia Li
- Department of Cardiology, Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, No.109 Xueyuan West Road, Lucheng District, Wenzhou 325000, Zhejiang, China
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Seow SC. A novel method to disengage trapped helix during left bundle branch pacing. Heart Rhythm 2024:S1547-5271(24)00283-2. [PMID: 38508298 DOI: 10.1016/j.hrthm.2024.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/13/2024] [Accepted: 03/14/2024] [Indexed: 03/22/2024]
Affiliation(s)
- Swee-Chong Seow
- Department of Cardiology, National University Hospital, Singapore.
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3
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Wasserlauf J, Knight BP. Comparing the safety and effectiveness of dedicated radiofrequency transseptal wires to electrified metal guidewires. J Cardiovasc Electrophysiol 2022; 33:371-379. [PMID: 34978365 PMCID: PMC9303383 DOI: 10.1111/jce.15341] [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: 07/31/2021] [Revised: 11/10/2021] [Accepted: 12/06/2021] [Indexed: 12/04/2022]
Abstract
Background Application of electrocautery to a metal guidewire is used by some operators to perform transseptal puncture (TSP). Commercially available dedicated radiofrequency (RF) guidewires may represent a better alternative. This study compares the safety and effectiveness of electrified guidewires to a dedicated RF wire. Methods TSP was performed on freshly excised porcine hearts using an electrified 0.014″ or 0.032″ guidewire under various power settings and was compared to TSP using a dedicated RF wire with 5 W power (0.035″ VersaCross RF System, Baylis Medical). The primary endpoint was the number of attempts required to achieve TSP. Secondary endpoints included the rate of TSP failure, TSP consistency, the effect of the distance between the tip of the guidewire and the tip of the dilator, and effect of RF power output level. Qualitative secondary endpoints included tissue puncture defect appearance, thermal damage to the TSP guidewire or dilator, and tissue temperature using thermal imaging. Results The RF wire required on average 1.10 ± 0.47 attempts to cross the septum. The 0.014″ electrified guidewire required an overall mean of 2.17 ± 2.36 attempts (2.0 times as many as the RF wire; p < .01), and the 0.032″ electrified guidewire required an overall mean of 3.90 ± 2.93 attempts (3.5 times as many as the RF wire; p < .01). Electrified guidewires had a higher rate of TSP failure, and caused larger defects and more tissue charring than the RF wire. Thermal analysis showed higher temperatures and a larger area of tissue heating with electrified guidewires than the RF wire. Conclusion Fewer RF applications were required to achieve TSP using a dedicated RF wire compared to an electrified guidewire. Smaller defects and lower tissue temperatures were also observed using the RF wire. Electrified guidewires required greater energy delivery and were associated with equipment damage and tissue charring, which may present a risk of thrombus, thermal injury, or scarring.
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Affiliation(s)
- Jeremiah Wasserlauf
- Department of Internal Medicine, Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Bradley P Knight
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Gowda ST, Qureshi AM, Turner D, Madan N, Weigand J, Lorber R, Singh HR. Transseptal puncture using surgical electrocautery in children and adults with and without complex congenital heart disease. Catheter Cardiovasc Interv 2017; 90:E46-E54. [PMID: 28766834 DOI: 10.1002/ccd.27202] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 06/15/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND Atrial transseptal puncture (TSP) for cardiac catheterization procedures remain challenging in children and adults with complex congenital heart disease (CHD). OBJECTIVES We sought to evaluate our experience using radiofrequency (RF) current via surgical electrocautery needle for TSP to facilitate diagnostic and interventional procedures. METHODS Retrospective chart review of all patients (pts) who underwent TSP using RF energy (10-25 W) via surgical electrocautery from three centers from January 2011 to January 2017 were evaluated. Echocardiograms were reviewed to define the atrial septum as normal and complex (thin aneurysmal, thick/fibrotic, synthetic patch material, and extra cardiac conduit). RESULTS A total of 54 pts underwent 55 successful TSP. Median age was 12.5 years (1 day-54 years) and weight was 52.7 kg (2-162). Indications for TSP included; EP study and ablation procedures in structurally normal hearts (n = 24) and in complex atrial septum/CHD and structural heart disease pts (n = 30): Electrophysiology study and ablation in 4, diagnostic catheterization in 9, and interventional procedures in 17 pts were performed. Atrial TSP was successful in 54/55 (98%). Atrial perforation with tiny-small pericardial effusion not requiring intervention was noted in 2 pts. TSP was unsuccessful in one critically ill neonate with unobstructed TAPVR and restricted atrial septum who experienced cardiac arrest requiring CPR, ECMO, and emergent surgery. CONCLUSIONS RF current delivery using surgical electrocautery for TSP is a feasible and an effective option in patients with complex CHD for diagnostic, interventional, and electrophysiology procedures.
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Affiliation(s)
- Srinath T Gowda
- Pediatric Cardiology, The Children's Hospital of San Antonio, Baylor College of Medicine, San Antonio, Texas.,Pediatric Cardiology, Children's Hospital of Michigan, Detroit Medical Center, Detroit, Michigan
| | - Athar M Qureshi
- Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Daniel Turner
- Pediatric Cardiology, Children's Hospital of Michigan, Detroit Medical Center, Detroit, Michigan
| | - Nitin Madan
- Pediatric Cardiology, The Children's Hospital of San Antonio, Baylor College of Medicine, San Antonio, Texas
| | - Justin Weigand
- Pediatric Cardiology, The Children's Hospital of San Antonio, Baylor College of Medicine, San Antonio, Texas
| | - Richard Lorber
- Pediatric Cardiology, The Children's Hospital of San Antonio, Baylor College of Medicine, San Antonio, Texas
| | - Harinder R Singh
- Pediatric Cardiology, The Children's Hospital of San Antonio, Baylor College of Medicine, San Antonio, Texas.,Pediatric Cardiology, Children's Hospital of Michigan, Detroit Medical Center, Detroit, Michigan
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Nakatani Y, Yamaguchi Y, Sakamoto T, Kinugawa K. Cryoballoon ablation with left lateral decubitus position in atrial fibrillation patient where the left atrium was compressed by the vertebra. Clin Case Rep 2017; 5:1381-1384. [PMID: 28781863 PMCID: PMC5538046 DOI: 10.1002/ccr3.1069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 05/10/2017] [Accepted: 06/13/2017] [Indexed: 12/23/2022] Open
Abstract
Catheter ablation of atrial fibrillation is difficult when the left atrium is compressed by the vertebra. The heart may shift forward, and compression of the left atrium may be relieved in the left lateral decubitus position. Therefore, catheter ablation could be performed in the left lateral decubitus position even in such cases.
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Affiliation(s)
- Yosuke Nakatani
- Second Department of Internal Medicine; University of Toyama; Toyama Japan
| | - Yoshiaki Yamaguchi
- Second Department of Internal Medicine; University of Toyama; Toyama Japan
| | - Tamotsu Sakamoto
- Second Department of Internal Medicine; University of Toyama; Toyama Japan
| | - Koichiro Kinugawa
- Second Department of Internal Medicine; University of Toyama; Toyama Japan
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Graham AJ, Honarbakhsh S, O'Brien B, Schilling RJ. A Simplified Trans-Septal Puncture Technique using a Needle Free Approach for Cryoablation of Atrial Fibrillation. J Atr Fibrillation 2017; 10:1628. [PMID: 29250235 DOI: 10.4022/jafib.1628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 07/19/2017] [Accepted: 08/24/2017] [Indexed: 11/10/2022]
Abstract
Background Trans-septal puncture (TSP) is routinely performed during treatment of atrial fibrillation (AF) and other electrophysiology procedures. The purpose of this retrospective observational study was the analysis of a novel needle free technique employed to gain access to the left atrium (LA). Methods The SafeSept Needle Free guidewire was delivered, using no needle, to the interatrial septum via a standard cryoablation sheath and dilator under transoesophageal guidance. The wire was then advanced into the LA with position confirmed by fluoroscopy. All cases were performed under general anaeasthetic (GA). Results The novel procedure was performed in 43 patients (38 paroxysmal AF (88.4%) and 5 persistent AF (11.4%)) with 100% success rate in accessing the LA. The procedure times (51.70 ±18.18) and fluoroscopy times (2.75 ± 3.35) were recorded. There were no complications seen in the cohort. Conclusion Using SafeSept Needle Free wire for TSP had a high success rate and resulted in no complications, with the potential to reduce procedure and fluoroscopy times.
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Affiliation(s)
- Adam J Graham
- This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.,This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.,This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation
| | - Shohreh Honarbakhsh
- This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation
| | - Ben O'Brien
- This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation
| | - Richard J Schilling
- This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation
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A Novel Deep Inspiration Maneuver for Difficult Transseptal Puncture. Am J Cardiol 2017; 119:428-433. [PMID: 27884419 DOI: 10.1016/j.amjcard.2016.10.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 10/11/2016] [Accepted: 10/11/2016] [Indexed: 11/23/2022]
Abstract
Transseptal puncture (TSP) may not be possible in cases of an elastic, aneurysmal, or thickened interatrial septum (IAS). During deep inspiration (DI), the chest wall expands and the diaphragm descends. This makes intrapleural pressure to become more negative, which leads to movement of the IAS to the right side. The aim of this study was to verify prospectively the feasibility, safety, and outcome of DI associated with conventional TSP technique in patients with challenging IAS anatomy. From September 2012 to May 2016, 224 patients underwent TSP due to different indications. Patients were divided into 2 groups: 213 patients in whom the left atrium was successfully accessed in 3 attempts were grouped as conventional TSP group and 11 patients in whom left atrium access was failed after 3 conventional attempts were grouped as DI-TSP group. Conventional TSP was successful in 89.6% of patients with the first attempt. Second and third attempts were required in 4.1% and 1.4%, respectively. Septal puncture was achieved at the first attempt in 10 patients within a median of 1 second of DI maneuver (interquartile range, 1 to 3) and without any complications. Challenging IAS anatomy consisting of IAS aneurysm, a thick IAS, and an excessively mobile IAS were more frequent in the DI-TSP group (45% to 8%, 27% to 3%, and 21% to 5%, respectively, p <0.001). In conclusion, TSP by using the DI maneuver may be a reliable and safe method after failed conventional attempts. If there is any doubt about the correct location of the needle, additional imaging modalities have to be used.
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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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Sulkin MS, Berwick ZC, Hermiller JB, Navia JA, Kassab GS. Suction catheter for enhanced control and accuracy of transseptal access. EUROINTERVENTION 2016; 12:1534-1541. [PMID: 27998846 DOI: 10.4244/eij-d-15-00344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Percutaneous structural heart therapies, such as mitral value repair, require site-specific transseptal access (TSA). This can be challenging for interventional cardiologists. We describe a TSA catheter (TSAC) that utilises suction for enhanced control and puncture accuracy. Here, we aim to evaluate the safety and efficacy of the device. METHODS AND RESULTS Ex vivo interatrial septum preparations were dissected from swine (n=8) and diseased human hearts (n=6) to quantify TSAC suction and needle puncture force. TSAC suction was 6.5-fold greater than the opposing needle puncture force, and thus provides sufficient stabilisation for punctures. The safety and efficacy of TSAC was evaluated in a chronic mitral regurgitation swine model (n=10) and compared to a conventional TSA device. MR was induced by disrupting one to three mitral chordae tendineae, and the progression of heart disease was followed for three weeks. During device testing, procedure time and fluoroscopy exposure were not statistically different between devices. TSAC reduced septal displacement from 8.7±0.30 mm to 3.60±0.19 mm (p<0.05) and improved puncture accuracy 1.75-fold. CONCLUSIONS TSAC provides controlled TSA and improves puncture accuracy, while maintaining procedure time and workflow. These findings provide a strong rationale for a first-in-man study to demonstrate the clinical utility of the device.
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Baszko A, Kałmucki P, Dankowski R, Łanocha M, Siminiak T, Szyszka A. Transseptal puncture from the jugular vein and balloon cryoablation for atrial fibrillation in a patient with azygos continuation of an interrupted inferior vena cava. Europace 2015; 17:1153-6. [DOI: 10.1093/europace/euu413] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 12/24/2014] [Indexed: 02/07/2023] Open
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Comparison of a Radiofrequency Powered Flexible Needle with a Classic Rigid Brockenbrough Needle for Transseptal Punctures in Terms of Safety and Efficacy. Heart Lung Circ 2015; 24:173-8. [DOI: 10.1016/j.hlc.2014.07.073] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 04/29/2014] [Accepted: 07/28/2014] [Indexed: 12/26/2022]
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Hsu JC, Badhwar N, Gerstenfeld EP, Lee RJ, Mandyam MC, Dewland TA, Imburgia KE, Hoffmayer KS, Vedantham V, Lee BK, Tseng ZH, Scheinman MM, Olgin JE, Marcus GM. Randomized trial of conventional transseptal needle versus radiofrequency energy needle puncture for left atrial access (the TRAVERSE-LA study). J Am Heart Assoc 2013; 2:e000428. [PMID: 24045120 PMCID: PMC3835257 DOI: 10.1161/jaha.113.000428] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Transseptal puncture is a critical step in achieving left atrial (LA) access for a variety of cardiac procedures. Although the mechanical Brockenbrough needle has historically been used for this procedure, a needle employing radiofrequency (RF) energy has more recently been approved for clinical use. We sought to investigate the comparative effectiveness of an RF versus conventional needle for transseptal LA access. Methods and Results In this prospective, single‐blinded, controlled trial, 72 patients were randomized in a 1:1 fashion to an RF versus conventional (BRK‐1) transseptal needle. In an intention‐to‐treat analysis, the primary outcome was time required for transseptal LA access. Secondary outcomes included failure of the assigned needle, visible plastic dilator shavings from needle introduction, and any procedural complication. The median transseptal puncture time was 68% shorter using the RF needle compared with the conventional needle (2.3 minutes [interquartile range {IQR}, 1.7 to 3.8 minutes] versus 7.3 minutes [IQR, 2.7 to 14.1 minutes], P=0.005). Failure to achieve transseptal LA access with the assigned needle was less common using the RF versus conventional needle (0/36 [0%] versus 10/36 [27.8%], P<0.001). Plastic shavings were grossly visible after needle advancement through the dilator and sheath in 0 (0%) RF needle cases and 12 (33.3%) conventional needle cases (P<0.001). There were no differences in procedural complications (1/36 [2.8%] versus 1/36 [2.8%]). Conclusions Use of an RF needle resulted in shorter time to transseptal LA access, less failure in achieving transseptal LA access, and fewer visible plastic shavings. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01209260.
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Affiliation(s)
- Jonathan C Hsu
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA
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ESCH JESSEJ, TRIEDMAN JOHNK, CECCHIN FRANK, ALEXANDER MARKE, WALSH EDWARDP. Radiofrequency-Assisted Transseptal Perforation for Electrophysiology Procedures in Children and Adults with Repaired Congenital Heart Disease. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 36:607-11. [DOI: 10.1111/pace.12092] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Revised: 10/24/2012] [Accepted: 11/24/2012] [Indexed: 12/01/2022]
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Raviele A, Natale A, Calkins H, Camm JA, Cappato R, Ann Chen S, Connolly SJ, Damiano R, DE Ponti R, Edgerton JR, Haïssaguerre M, Hindricks G, Ho SY, Jalife J, Kirchhof P, Kottkamp H, Kuck KH, Marchlinski FE, Packer DL, Pappone C, Prystowsky E, Reddy VK, Themistoclakis S, Verma A, Wilber DJ, Willems S. Venice Chart international consensus document on atrial fibrillation ablation: 2011 update. J Cardiovasc Electrophysiol 2013; 23:890-923. [PMID: 22953789 DOI: 10.1111/j.1540-8167.2012.02381.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Antonio Raviele
- Cardiovascular Department, Arrhythmia Center and Center for Atrial Fibrillation, Dell'Angelo Hospital, Venice-Mestre, Italy.
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Maisano F, La Canna G, Latib A, Godino C, Denti P, Buzzatti N, Taramasso M, Cioni M, Giacomini A, Colombo A, Alfieri O. Transseptal access for MitraClip® procedures using surgical diathermy under echocardiographic guidance. EUROINTERVENTION 2012; 8:579-86. [DOI: 10.4244/eijv8i5a89] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
Atrial fibrillation (AF) is the most common arrhythmia requiring treatment that is encountered in clinical practice. Recent advances in the understanding of underlying mechanisms of AF have led to the increased use of catheter ablation (CA) as a treatment modality for paroxysmal, persistent, or long-standing persistent AF in patients with symptomatic AF despite treatment with antiarrhythmic medications. Because of the complexity in technique and anatomic location of the ablation sites, it is not surprising that CA of AF is associated with a greater risk of procedural complications compared with simpler cardiac ablation procedures. Major and minor complications, including life-threatening complications, have been described and quantified. This systematic review describes the potential risks of CA that have been reported over a period and provides insights into the evolving strategies to minimize these complications, thus making CA techniques safer and potentially more efficacious for AF.
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17
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Approach to the Difficult Transseptal: Diathermy Facilitated Left Atrial Access. Heart Lung Circ 2012; 21:108-12. [DOI: 10.1016/j.hlc.2011.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 07/22/2011] [Indexed: 11/18/2022]
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Fromentin S, Sarrazin JF, Champagne J, Nault I, Philippon F, Molin F, Blier L, O’Hara G. Prospective comparison between conventional transseptal puncture and transseptal needle puncture with radiofrequency energy. J Interv Card Electrophysiol 2011; 31:237-42. [DOI: 10.1007/s10840-011-9564-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 03/04/2011] [Indexed: 10/18/2022]
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ELAYI CLAUDESAMY, GURLEY JOHNCARL, DI SESSA THOMASGERALD, KAKAVAND BAHRAM. Surgical Electrocautery Facilitated Transseptal Puncture in Children. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 34:827-31. [DOI: 10.1111/j.1540-8159.2011.03056.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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MIYAZAKI SHINSUKE, SHAH ASHOKJ, NAULT ISABELLE, WRIGHT MATTHEW, JADIDI AMIRS, FORCLAZ ANDREI, LIU XINGPENG, LINTON NICK, XHAËT OLIVIER, RIVARD LENA, DERVAL NICOLAS, SACHER FRÉDÉRIC, HOCINI MÉLÈZE, JAÏS PIERRE, HAÏSSAGUERRE MICHEL. Impact of Patent Foramen Ovale on Left Atrial Linear Lesions in the Context of Atrial Fibrillation Ablation. J Cardiovasc Electrophysiol 2011; 22:846-50. [DOI: 10.1111/j.1540-8167.2010.02007.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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SY RAYMONDW, KLEIN GEORGEJ, LEONG-SIT PETER, GULA LORNEJ, YEE RAYMOND, KRAHN ANDREWD, SKANES ALLANC. Troubleshooting Difficult Transseptal Catheterization. J Cardiovasc Electrophysiol 2011; 22:723-7. [DOI: 10.1111/j.1540-8167.2010.01987.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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De Ponti R. Transseptal catheterization for ablation in the left heart: what to do when the door is locked up tight? Europace 2010; 12:604-5. [PMID: 20382969 DOI: 10.1093/europace/euq099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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SMELLEY MATTHEWP, SHAH DIPAKP, WEISBERG IAN, KIM SUSANS, LIN ALBERTC, BESHAI JOHNF, BURKE MARTINC, KNIGHT BRADLEYP. Initial Experience Using a Radiofrequency Powered Transseptal Needle. J Cardiovasc Electrophysiol 2010; 21:423-7. [DOI: 10.1111/j.1540-8167.2009.01656.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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De Ponti R, Marazzi R, Picciolo G, Salerno-Uriarte JA. Use of a novel sharp-tip, J-shaped guidewire to facilitate transseptal catheterization. Europace 2010; 12:668-73. [PMID: 20228079 DOI: 10.1093/europace/euq060] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIMS Transseptal catheterization (TSP-C) is a demanding procedure and at the same time one of the key points of atrial fibrillation ablation, an increasingly diffused procedure. This study prospectively evaluates the usefulness of a novel sharp-tip, J-shaped 0.014'' transseptal guidewire (TSP-GW) to facilitate TSP-C in case of resistant atrial septum (AS). METHODS AND RESULTS Consecutive patients undergoing TSP-C for arrhythmia ablation in a single centre were considered for the study. TSP-C was performed according to a standardized technique. The criterion to use the TSP-GW was a resistant AS, defined as inability to perforate the fossa ovalis by applying moderate pressure to a standard Brockenbrough needle. The TSP-GW was inserted in the needle lumen and advanced to puncture the AS and enter the left atrium; subsequently, the transseptal assembly was advanced over the TSP-GW. Double transseptal puncture was routinely performed for ablation of atrial fibrillation. Eighty-one patients (54 males, 27 females; mean age 54 +/- 17 years, range 12-81) undergoing TSP-C were enrolled; 132 TSP-C procedures were planned and accomplished. Nineteen patients (23%) in 27 procedures showed a resistant AS. In all these procedures, the TSP-GW was safely and successfully used to accomplish the TSP-C. In patients with a resistant AS, only a significantly lower prevalence of structural heart disease was observed when compared with controls. No complication related to TSP-C was observed. CONCLUSION The TSP-GW facilitates TSP-C in 23% of the patients, in whom a resistant AS is encountered. In this population, there was no clinical predictor of such anatomy.
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Affiliation(s)
- Roberto De Ponti
- Department of Heart, Brain and Vessels, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Viale Borri, 57, IT-21100 Varese, Italy.
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SHAH ASHOKJ, JANES RENEE, HOLLIDAY JEFFREY, THAKUR RANJAN. Radiofrequency Transseptal Catheter Electrode Fracture. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:e57-8. [DOI: 10.1111/j.1540-8159.2010.02708.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Capulzini L, Paparella G, Sorgente A, de Asmundis C, Chierchia GB, Sarkozy A, Muller-Burri A, Yazaki Y, Roos M, Brugada P. Feasibility, safety, and outcome of a challenging transseptal puncture facilitated by radiofrequency energy delivery: a prospective single-centre study. Europace 2010; 12:662-7. [DOI: 10.1093/europace/euq019] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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TZEIS STYLIANOS, ANDRIKOPOULOS GEORGE, DEISENHOFER ISABEL, HO SIEWYEN, THEODORAKIS GEORGE. Transseptal Catheterization: Considerations and Caveats. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:231-42. [DOI: 10.1111/j.1540-8159.2009.02598.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Kim SS, Hijazi ZM, Lang RM, Knight BP. The use of intracardiac echocardiography and other intracardiac imaging tools to guide noncoronary cardiac interventions. J Am Coll Cardiol 2009; 53:2117-28. [PMID: 19497437 DOI: 10.1016/j.jacc.2009.01.071] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2008] [Revised: 01/06/2009] [Accepted: 01/19/2009] [Indexed: 10/20/2022]
Abstract
The limitations of standard fluoroscopy have led to the development of improved imaging techniques to guide noncoronary cardiac interventions. Imaging tools that are used in the interventional laboratory can be categorized as invasive and noninvasive. Noninvasive cardiac imaging tools include ultrasound, computed tomography, and magnetic resonance imaging. These modalities can generate high-resolution images of the heart and are increasingly being used to guide cardiac interventions. Despite these advances, there remains a strong role for invasive imaging tools in the interventional laboratories. Such invasive imaging tools include transesophageal echocardiography, intracardiac echocardiography, intracardiac endoscopy, and electroanatomic mapping systems. Despite the risks inherent to the invasive nature of these tools, these modalities can provide excellent real-time, detailed images that can be invaluable in guiding certain cardiac interventions. This review will propose the features of an ideal intracardiac imaging tool, summarize the intracardiac imaging tools that are currently available or under development to guide noncoronary cardiac interventional procedures, and suggest opportunities for improvement. One opportunity in this field is to couple imaging systems directly with the interventional devices themselves. The use of intracardiac imaging to guide select cardiac procedures including transseptal catheterization, catheter ablation procedures for arrhythmias, and percutaneous placement of cardiac valves and closure devices will also be discussed. Most of this review will be devoted to intracardiac echocardiography, which currently has the broadest number of applications.
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Affiliation(s)
- Susan S Kim
- Department of Internal Medicine, University of Chicago, Illinois, USA
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