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Cheng H, Bangash AB, Tao Y, Jiang R, Liu Q, Cheng C, Fu G, Jiang C. Intracardiac echocardiography guided electrified J-wire trans-septal puncture: A prospective randomized controlled trial. Pacing Clin Electrophysiol 2024; 47:448-454. [PMID: 38291877 DOI: 10.1111/pace.14916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/08/2023] [Accepted: 12/21/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Application of electrocautery to a J-wire is used to perform transseptal puncture (TSP), but with limited evidence supporting safety and efficacy. We conducted a prospective randomized controlled trial to evaluate the safety and efficacy of this technique. METHODS Two hundred consecutive patients were randomized in a 1:1 fashion to either the ICE-guided electrified J-wire TSP group or a conventional Brockenbrough (BRK) needle TSP group. The TSP was performed with a 0.032″ guidewire under 20 W, "coag" mode and was compared to TSP using the BRK needle. The primary safety endpoints were complications related to TSP. The primary efficacy endpoints included the TSP success rate, the total TSP time, and the total procedure time. RESULTS All patients complete the procedure safely. The electrified J-wire TSP group had a significantly shorter TSP time than BRK needle TSP group. The total procedure time, number of TSP attempts required to achieve successful LA access, width of the intra-atrial shunt at the end of ablation were similar between the two groups. The incidence of new cerebral infarction detected by MRI were similar between the two groups (3/32 patients in the J-wire TSP group and 2/26 patients in conventional BRK TSP group, p = .82). And no difference in the incidence of residual intra-atrial shunt (4.3% vs. 6%, p = .654) during the 3-month's follow up. CONCLUSION Using an electrified J-wire for TSP under the guidance of ICE appears to be as safe as and more efficient than conventional BRK needle TSP, which may be especially useful in the era of non-fluoroscopy AF ablation.
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Affiliation(s)
- Hui Cheng
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, Zhejiang, P. R. China
| | - Abdul Basit Bangash
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, Zhejiang, P. R. China
| | - Yuhang Tao
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, Zhejiang, P. R. China
| | - Ruhong Jiang
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, Zhejiang, P. R. China
| | - Qiang Liu
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, Zhejiang, P. R. China
| | - Cheng Cheng
- Department of Cardiology, The Second Hospital of Anhui Medical University, HeFei, Anhui, P. R. China
| | - Guosheng Fu
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, Zhejiang, P. R. China
| | - Chenyang Jiang
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, Zhejiang, P. R. China
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Isgandarova K, Braun M, Sciacca V, Fink T, Hamriti ME, Khalaph M, Guckel D, Sohns C, Sommer P, Imnadze G. Anatomical orientation lines for localization of the transseptal puncture site in a 3D electroanatomical map. J Interv Card Electrophysiol 2023; 66:1787-1790. [PMID: 37249808 PMCID: PMC10570213 DOI: 10.1007/s10840-023-01571-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 05/16/2023] [Indexed: 05/31/2023]
Affiliation(s)
- Khuraman Isgandarova
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany
| | - Martin Braun
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany
| | - Vanessa Sciacca
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany
| | - Thomas Fink
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany
| | - Mustapha El Hamriti
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany
| | - Moneeb Khalaph
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany
| | - Denise Guckel
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany
| | - Christian Sohns
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany
| | - Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany
| | - Guram Imnadze
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany.
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Bohnen M, Minners J, Eichenlaub M, Weber R, Allgeier HJ, Jadidi A, Neumann FJ, Westermann D, Arentz T, Lehrmann H. Feasibility and safety of a three-dimensional anatomic map-guided transseptal puncture for left-sided catheter ablation procedures. Europace 2023; 25:1126-1134. [PMID: 36610064 PMCID: PMC10062364 DOI: 10.1093/europace/euac262] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 11/28/2022] [Indexed: 01/09/2023] Open
Abstract
AIMS Transseptal puncture (TP) for left-sided catheter ablation procedures is routinely performed under fluoroscopic or echocardiographic guidance [transoesophageal echocardiography (TEE) or intracardiac echocardiography (ICE)], although three-dimensional (3D) mapping systems are readily available in most electrophysiology laboratories. Here, we sought to assess the feasibility and safety of a right atrial (RA) 3D map-guided TP. METHODS AND RESULTS In 104 patients, 3D RA mapping was performed to identify the fossa ovalis (FO) using the protrusion technique. The radiofrequency transseptal needle was visualized and navigated to the desired potential FO-TP site. Thereafter, the interventionalist was unblinded to TEE and the potential FO-TP site was reassessed regarding its convenience and safety. After TP, the exact TP site was documented using a 17-segment-FO model. Reliable identification of the FO was feasible in 102 patients (98%). In these, 114 3D map-guided TP attempts were performed, of which 96 (84%) patients demonstrated a good position and 18 (16%) an adequate position after TEE unblinding. An out-of-FO or dangerous position did not occur. A successful 3D map-guided TP was performed in 110 attempts (97%). Four attempts (3%) with adequate positions were aborted in order to seek a more convenient TP site. The median time from RA mapping until the end of the TP process was 13 (12-17) min. No TP-related complications occurred. Ninety-eight TP sites (85.1%) were in the central portion or in the inner loop of the FO. CONCLUSION A 3D map-guided TP is feasible and safe. It may assist to decrease radiation exposure and the need for TEE/ICE during left-sided catheter ablation procedures.
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Affiliation(s)
- Marius Bohnen
- Department of Cardiology and Angiology (Campus Bad Krozingen), Heart Center, University Hospital Freiburg, Südring 15, 79189 Bad Krozingen, Germany
| | - Jan Minners
- Department of Cardiology and Angiology (Campus Bad Krozingen), Heart Center, University Hospital Freiburg, Südring 15, 79189 Bad Krozingen, Germany
| | - Martin Eichenlaub
- Department of Cardiology and Angiology (Campus Bad Krozingen), Heart Center, University Hospital Freiburg, Südring 15, 79189 Bad Krozingen, Germany
| | - Reinhold Weber
- Department of Cardiology and Angiology (Campus Bad Krozingen), Heart Center, University Hospital Freiburg, Südring 15, 79189 Bad Krozingen, Germany
| | - Hans-Jürgen Allgeier
- Department of Cardiology and Angiology (Campus Bad Krozingen), Heart Center, University Hospital Freiburg, Südring 15, 79189 Bad Krozingen, Germany
| | - Amir Jadidi
- Department of Cardiology and Angiology (Campus Bad Krozingen), Heart Center, University Hospital Freiburg, Südring 15, 79189 Bad Krozingen, Germany
| | - Franz-Josef Neumann
- Department of Cardiology and Angiology (Campus Bad Krozingen), Heart Center, University Hospital Freiburg, Südring 15, 79189 Bad Krozingen, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology (Campus Bad Krozingen), Heart Center, University Hospital Freiburg, Südring 15, 79189 Bad Krozingen, Germany
| | - Thomas Arentz
- Department of Cardiology and Angiology (Campus Bad Krozingen), Heart Center, University Hospital Freiburg, Südring 15, 79189 Bad Krozingen, Germany
| | - Heiko Lehrmann
- Department of Cardiology and Angiology (Campus Bad Krozingen), Heart Center, University Hospital Freiburg, Südring 15, 79189 Bad Krozingen, Germany
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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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