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Khalaph M, Lucas P, Schenker N, Rillig A, Heeger CH, El Hamriti M, Didenko M, Beyer S, Guckel D, Fink T, Sciacca V, Mörsdorf M, Braun M, Ivannikova M, Scholtz W, Rudolph V, Imnadze G, Sohns C, Metzner A, Sommer P. Transseptal puncture for catheter ablation of atrial fibrillation in patients with septal occluder devices. Heart Rhythm 2025:S1547-5271(25)02299-4. [PMID: 40187509 DOI: 10.1016/j.hrthm.2025.03.1996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2025] [Revised: 03/14/2025] [Accepted: 03/29/2025] [Indexed: 04/07/2025]
Abstract
BACKGROUND Transseptal puncture (TSP) is critical for atrial fibrillation (AF) ablation. However, patients with atrial septal occluders (ASOs) for atrial septal defects (ASDs) or persistent foramen ovale (PFO) pose unique challenges. OBJECTIVE This study aimed to evaluate the peri- and postprocedural safety, AF recurrence, and incidence of newly developed ASD/PFO up to 12 months postprocedure. METHODS This multicenter, prospective observational study included 59 patients (mean age 61.2 ± 12.1 years, 56% male) with drug-refractory AF who underwent pulmonary vein isolation (PVI) between 2019 and 2024. Of these patients, 38 had ASDs and 21 had PFOs, with ASOs in situ. All punctures (single TSP) were performed under fluoroscopic guidance. RESULTS The majority of TSP positions in the interatrial septum related to the ASO was inferior-posterior to the ASO (66.1%) or inferior-anterior (23.7%). In case of failure of the inferior part, puncture was performed in superior-posterior puncture (8.5%) or puncture through the occluder (1.7%). Mean ablation time was 14.9 ± 8.4 minutes, including radiofrequency (83.0%), cryoballoon (11.9%), and pulsed field ablation (5.1%). No major complications were observed, except for 1 transient phrenic nerve palsy during cryoballoon ablation, which recovered intraprocedurally. Voltage mapping revealed no additional substrate related to the occluder. During 12-month follow-up, 7 patients (11.9%) experienced AF recurrence. CONCLUSION TSP and PVI are safe and can be safely performed in patients with an ASO. No additional substrate related to the occluder was seen. Although no direct comparison was made, outcomes align with existing literature. Further studies are needed.
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Affiliation(s)
- Moneeb Khalaph
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.
| | - Philipp Lucas
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Niklas Schenker
- Department of Cardiac Electrophysiology, University Heart and Vascular Center, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Andreas Rillig
- Department of Cardiac Electrophysiology, University Heart and Vascular Center, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Christian-Hendrik Heeger
- Department für Rhythmologie, Abteilung für Kardiologie & Internistische Intensivmedizin, Asklepios Klinik Altona, Hamburg, Germany
| | - Mustapha El Hamriti
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Maxim Didenko
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Sebastian Beyer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Denise Guckel
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Thomas Fink
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Vanessa Sciacca
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Max Mörsdorf
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Martin Braun
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Maria Ivannikova
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Werner Scholtz
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Volker Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Guram Imnadze
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Christian Sohns
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Andreas Metzner
- Department of Cardiac Electrophysiology, University Heart and Vascular Center, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
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Pacheco-Bouthillier AD, Miguel-González JJ, González-Martínez A, Everding-Rodríguez AG, Gómez-Delgadillo SS, Chávez-Torres ÁE, Fregoso-Sánchez A, Ferreira-Piña B, Lomelí-Sánchez ÓS, Coutiño-Moreno HE, Mariona-Montero VA. Needle-free atrial transseptal access: A safe and reproducible alternative for left atrial catheterization. Heart Rhythm O2 2024; 5:788-795. [PMID: 39651438 PMCID: PMC11624409 DOI: 10.1016/j.hroo.2024.09.005] [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] [Indexed: 12/11/2024] Open
Abstract
Background Left atrial catheterization is a common procedure in electrophysiology labs to treat arrhythmogenic substrates on the left side of the heart. Needle transseptal puncture is the standard approach, but it can lead to complications related to device design or operator technique. To reduce these complications, needle-free alternatives have been explored. Objective This study aims to report the first multicenter application of the needle-free transseptal access (NeFTA) approach, assessing its safety and efficacy in patients undergoing electrophysiological procedures. Methods This retrospective, observational multicenter study evaluated the safety and efficacy of the NeFTA approach in patients undergoing ablation of left arrhythmogenic substrates across 3 electrophysiology centers in Mexico. NeFTA uses only a guidewire, without a needle or sharp guidewire. The sheath, with a dilator, is guided into the fossa ovalis under fluoroscopic guidance, using anterior force and clockwise torque to allow the guidewire to puncture the septum with minimal risk. Results The NeFTA technique was used in 366 patients. Most sheaths were deflectable, with nondeflectable sheaths in 43.4% of cases. Left atrial access via NeFTA was successful in 96.18% of cases, with pericardial effusion as the only complication (0.55% rate). Conclusion This technique was reproducible and safe, achieving successful access on the first or second attempt in 96.18% of cases, regardless of the operator.
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Affiliation(s)
- Alex D. Pacheco-Bouthillier
- Departamento de Investigación, Instituto Cardiovascular de Mínima Invasión, Zapopan, México
- Unidad de Electrofisiología, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, México
| | | | | | | | | | - Ángel E. Chávez-Torres
- Departamento de Investigación, Instituto Cardiovascular de Mínima Invasión, Zapopan, México
| | | | - Benigno Ferreira-Piña
- Departamento de Investigación, Instituto Cardiovascular de Mínima Invasión, Zapopan, México
| | - Óscar S. Lomelí-Sánchez
- Departamento de Investigación, Instituto Cardiovascular de Mínima Invasión, Zapopan, México
- Unidad de Cardiología, Hospital Civil Fray Antonio Alcalde, Guadalajara, Mexico
| | - Hugo E. Coutiño-Moreno
- Unidad de Electrofisiología, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, México
| | - Vitelio A. Mariona-Montero
- Unidad Médica de Alta Especialidad en Pediatría, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
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Zeidan AM, Xu Z, Leung L, Byrne C, Sabu S, Zhou Y, Rinaldi CA, Whitaker J, Williams SE, Behar J, Arujuna A, Housden RJ, Rhode K. An anthropomorphic phantom for atrial transseptal puncture simulation training. 3D Print Med 2024; 10:34. [PMID: 39472399 PMCID: PMC11523608 DOI: 10.1186/s41205-024-00241-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 10/18/2024] [Indexed: 11/02/2024] Open
Abstract
BACKGROUND Transseptal puncture (TSP) is a critical prerequisite for left-sided cardiac interventions, such as atrial fibrillation (AF) ablation and left atrial appendage closure. Despite its routine nature, TSP can be technically demanding and carries a risk of complications. This study presents a novel, patient-specific, anthropomorphic phantom for TSP simulation training that can be used with X-ray fluoroscopy and ultrasound imaging. METHODS The TSP phantom was developed using additive manufacturing techniques and features a replaceable fossa ovalis (FO) component to allow for multiple punctures without replacing the entire model. Four cardiologists and one cardiology trainee performed TSP on the simulator, and their performance was assessed using four metrics: global isotropy index, distance from the centroid, time taken to perform TSP, and a set of 5-point Likert scale questions to evaluate the clinicians' perception of the phantom's realism and utility. RESULTS The results demonstrate the simulator's potential as a training tool for interventional cardiology, providing a realistic and controllable environment for clinicians to refine their TSP skills. Experienced cardiologists tended to cluster their puncture points closer to regions of the FO associated with higher global isotropy index scores, indicating a relationship between experience and optimal puncture localization. The questionnaire analysis revealed that participants generally agreed on the phantom's realistic anatomical representation and ability to accurately visualize the TSP site under fluoroscopic guidance. CONCLUSIONS The TSP simulator can be incorporated into training programs, offering trainees the opportunity to improve tool handling, spatial coordination, and manual dexterity prior to performing the procedure on patients. Further studies with larger sample sizes and longitudinal assessments are needed to establish the simulator's impact on TSP performance and patient outcomes.
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Affiliation(s)
- Aya Mutaz Zeidan
- Department of Surgical & Interventional Engineering, King's College London, London, SE1 7EH, UK.
| | - Zhouyang Xu
- Department of Surgical & Interventional Engineering, King's College London, London, SE1 7EH, UK
| | - Lisa Leung
- Cardiology Department, Guy's & St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
- St. George's Hospital, NHS Foundation Trust, London, SW17 0QT, UK
| | - Calum Byrne
- Cardiology Department, Guy's & St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
| | - Sachin Sabu
- Cardiology Department, Guy's & St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
| | - Yijia Zhou
- Department of Surgical & Interventional Engineering, King's College London, London, SE1 7EH, UK
| | - Christopher Aldo Rinaldi
- Department of Surgical & Interventional Engineering, King's College London, London, SE1 7EH, UK
- Cardiology Department, Guy's & St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
| | - John Whitaker
- Department of Surgical & Interventional Engineering, King's College London, London, SE1 7EH, UK
- Cardiology Department, Guy's & St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
| | - Steven E Williams
- Department of Surgical & Interventional Engineering, King's College London, London, SE1 7EH, UK
- Center for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Jonathan Behar
- Department of Surgical & Interventional Engineering, King's College London, London, SE1 7EH, UK
- Cardiology Department, Guy's & St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
| | - Aruna Arujuna
- Department of Surgical & Interventional Engineering, King's College London, London, SE1 7EH, UK
| | - R James Housden
- Department of Surgical & Interventional Engineering, King's College London, London, SE1 7EH, UK
| | - Kawal Rhode
- Department of Surgical & Interventional Engineering, King's College London, London, SE1 7EH, UK
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Torsello GB, Silvano M, Torsello GF, Seçer R, Grambow E, Ormandzhieva TK, Elger F. Transprosthetic Fenestration With Electrified Wires. Experimental Evaluation of Three Multifilament Endografts. J Endovasc Ther 2024:15266028241284373. [PMID: 39364813 DOI: 10.1177/15266028241284373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2024]
Abstract
PURPOSE In situ fenestration of aortic endografts is an alternative endovascular technique for treatment of complex aortic aneurysms. While this technique has been carried out also to pass stent-grafts in individual cases, its feasibility and safety using different stent-grafts needs to be evaluated. METHODS In a saline bath at water temperature of 37°C, a 0.018" Astato 30 guidewire was advanced through 3 different stent-grafts (RelayPro, Zenith and Endurant II) by applying external current of 180 W via an electrosurgery pencil. Puncture efficacy and quality of the fenestration after ballooning with a 6 mm percutaneous transluminal angioplasty (PTA) catheter were assessed. Then, balloon-expandable covered stents were deployed in the fenestrations and evaluated for stenosis, using microscopy and radiography. RESULTS Crossing of the electrified guidewire was instantaneous in the Zenith (n:10) and RelayPro (n:10) groups but not in 3 of 10 punctures in the Endurant group (p<.05). The fenestration area created after PTA was significantly larger in the RelayPro (5.3 mm2 ± 1.8, interquartile range [IQR] 1.6) and Zenith group (6.7 mm2 ± 0.7, IQR 0.5) compared to Endurant (2.3 mm2 ± 0.4, IQR 0.5, p<.001). Fraying was observed in all groups while graft shredding was found in 8 cases after PTA of the Zenith and Endurant endografts and in 5 of the RelayPro group, but the difference was not significant. Vertical tearing was detected after RelayPro (2 out of 10) and Zenith (6 out of 10) fenestrations, no damage was found in the Endurant group (p<.01). Residual stenosis at the level of the fenestration after implantation of a 6 × 79 mm VBX stent had to be corrected in all Endurant cases with a high-pressure PTA catheter. No stenosis was found in the RelayPro and Zenith groups before and after flaring. CONCLUSIONS The "electrified wire" technique is a feasible tool that can be used to perform in situ fenestration by perforation of the endograft fabric. Based on this experimental evaluation the "ideal graft" for this technique could not be identified. Long-term fatigue tests and comparison with other fenestration techniques are required. CLINICAL IMPACT In situ endograft fenestration can be a useful technique in emergent aortic repair. Recently, the electrified wire technique has been proposed as alternative option to laser, radiofrequency and needle-based techniques. In comparison to these methods, the use of electrified wires can be performed without modifications of routine equipment. Additionally, the material costs can be substantially reduced. However, the effectiveness of this approach for fenestration of different prosthetic grafts is unknown. Based on our experimental studies, the electrified wire technique is feasible but the Endurant endograft requires more attempts, and the placement of a bridging stent should be completed with high-pressure balloons.
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Affiliation(s)
| | - Marcello Silvano
- Department of Vascular and Cardiothoracic Surgery, University of Göttingen, Göttingen, Germany
| | | | - Rukiye Seçer
- Department of Vascular and Cardiothoracic Surgery, University of Göttingen, Göttingen, Germany
| | - Eberhard Grambow
- Department of Vascular and Cardiothoracic Surgery, University of Göttingen, Göttingen, Germany
| | | | - Florian Elger
- Department of Vascular and Cardiothoracic Surgery, University of Göttingen, Göttingen, Germany
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Viana-Tejedor A, Ferrera C, Estévez-Loureiro R, Barreiro-Pérez M, Jiménez Quevedo P, Nombela-Franco L, Jorge-Pérez P, Pascual I, Martínez Monzonís A, Cid Álvarez AB. [Edge-to-edge therapy in acute mitral regurgitation. Proposal for a management protocol of the Ischemic Heart Disease and Acute Cardiac Care, Interventional Cardiology, and Cardiovascular Imaging Associations of the Spanish Society of Cardiology]. REC: INTERVENTIONAL CARDIOLOGY 2024; 6:313-320. [PMID: 40417346 PMCID: PMC12097375 DOI: 10.24875/recic.m24000464] [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: 03/03/2024] [Accepted: 04/24/2024] [Indexed: 05/27/2025] Open
Abstract
The approach to patients with acute mitral regurgitation poses a therapeutic challenge. These patients have a very high morbidity and mortality rate, thus requiring a multidisciplinary approach. This document presents the position of 3 associations involved in the management of these patients: the Ischemic Heart Disease and Acute Cardiovascular Care Association, the Interventional Cardiology Association, and the Cardiac Imaging Association. The document discusses aspects related to patient selection and care, technical features of the edge-to-edge procedure from both the interventional and imaging unit perspectives, and the outcomes of this process. The results of mitral repair and/or replacement surgery, which is the first-line treatment option to consider in these patients, have not been included as they exceed the scope of the aims of the document.
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Affiliation(s)
- Ana Viana-Tejedor
- Servicio de Cardiología, Hospital Universitario Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, EspañaServicio de CardiologíaHospital Universitario Clínico San CarlosInstituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC)MadridEspaña
| | - Carlos Ferrera
- Servicio de Cardiología, Hospital Universitario Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, EspañaServicio de CardiologíaHospital Universitario Clínico San CarlosInstituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC)MadridEspaña
| | - Rodrigo Estévez-Loureiro
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, Pontevedra, EspañaServicio de CardiologíaHospital Universitario Álvaro CunqueiroInstituto de Investigación Sanitaria Galicia Sur (IISGS)VigoEspaña
| | - Manuel Barreiro-Pérez
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, Pontevedra, EspañaServicio de CardiologíaHospital Universitario Álvaro CunqueiroInstituto de Investigación Sanitaria Galicia Sur (IISGS)VigoEspaña
| | - Pilar Jiménez Quevedo
- Servicio de Cardiología, Hospital Universitario Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, EspañaServicio de CardiologíaHospital Universitario Clínico San CarlosInstituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC)MadridEspaña
| | - Luis Nombela-Franco
- Servicio de Cardiología, Hospital Universitario Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, EspañaServicio de CardiologíaHospital Universitario Clínico San CarlosInstituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC)MadridEspaña
| | - Pablo Jorge-Pérez
- Servicio de Cardiología, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, EspañaServicio de CardiologíaHospital Universitario de CanariasLa LagunaEspaña
| | - Isaac Pascual
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, EspañaServicio de CardiologíaHospital Universitario Central de AsturiasOviedoEspaña
- Departamento de Medicina, Universidad de Oviedo, Oviedo, Asturias, EspañaDepartamento de MedicinaUniversidad de OviedoOviedoEspaña
| | - Amparo Martínez Monzonís
- Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, A Coruña, EspañaServicio de CardiologíaHospital Clínico Universitario de Santiago de CompostelaInstituto de Investigación Sanitaria de Santiago (IDIS)Santiago de CompostelaEspaña
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), EspañaCentro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)España
| | - Ana Belén Cid Álvarez
- Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, A Coruña, EspañaServicio de CardiologíaHospital Clínico Universitario de Santiago de CompostelaInstituto de Investigación Sanitaria de Santiago (IDIS)Santiago de CompostelaEspaña
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), EspañaCentro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)España
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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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Hu F, Xu B, Qiao Z, Cheng F, Zhou Z, Zou Z, Zang M, Ding S, Hong J, Xie Y, Zhou Y, Huang J, Pu J. Angioplasty Guidewire-Assisted vs. Conventional Transseptal Puncture for Left Atrial Appendage Occlusion: a multicentre randomized controlled trial. Europace 2023; 25:euad349. [PMID: 38011331 PMCID: PMC10751848 DOI: 10.1093/europace/euad349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/02/2023] [Indexed: 11/29/2023] Open
Abstract
AIMS This study was performed to compare the usability, efficiency, and safety of a modified angioplasty guidewire-assisted transseptal puncture (TSP) technique vs. the conventional approach in facilitating access into the left atrium during left atrial appendage occlusion (LAAO) procedures for the treatment of atrial fibrillation. METHODS AND RESULTS The ADVANCE-LAAO trial (Angioplasty Guidewire-Assisted vs. Conventional Transseptal Puncture for Left Atrial Appendage Occlusion) was an investigator-initiated, prospective, multicentre, randomized controlled trial (NCT05125159). Patients with atrial fibrillation who underwent LAAO were prospectively enrolled from four centres and randomly assigned to an angioplasty guidewire-assisted TSP group (n = 131) or to a conventional Brockenbrough needle TSP group (n = 132). The primary endpoint was the one-time success rate of TSP. We also analysed the TSP procedure time, failure rate of the assigned TSP type, radiation dose, contrast dose, and procedural complications in both groups. All patients in the guidewire-assisted group underwent successful TSP, whereas five in the standard conventional group switched to the guidewire-assisted approach. The guidewire-assisted puncture improved the one-time success rate (92.4 vs. 77.3%, P = 0.001), shortened the TSP procedure time (109.2 ± 48.2 vs. 120.5 ± 57.6 s, P = 0.023), and tended to have a higher rate of good coaxial orientation of the sheath with the left atrial appendage during the LAAO procedure (66.4 vs. 54.5%, P = 0.059). No TSP-related complications occurred in the guidewire-assisted TSP group, whereas two complications occurred in the conventional TSP group. There was no significant difference in the failure rate of the assigned TSP type, the total procedure time, the total radiation dose, the rate of successful LAAO implantation, or the procedural complication rate between the two groups (all P > 0.05). CONCLUSION This study confirmed that angioplasty guidewire-assisted puncture can effectively improve the success rate of TSP during LAAO procedures. This novel technique has high potential for application in interventional therapies requiring TSP.
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Affiliation(s)
- Feng Hu
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160# PuJian Road, Shanghai 200127, China
| | - Bin Xu
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160# PuJian Road, Shanghai 200127, China
| | - Zhiqing Qiao
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160# PuJian Road, Shanghai 200127, China
| | - Fuyu Cheng
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160# PuJian Road, Shanghai 200127, China
| | - Zien Zhou
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160# PuJian Road, Shanghai 200127, China
| | - Zhiguo Zou
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160# PuJian Road, Shanghai 200127, China
| | - Minhua Zang
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160# PuJian Road, Shanghai 200127, China
| | - Song Ding
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160# PuJian Road, Shanghai 200127, China
| | - Jun Hong
- Department of Cardiology, Ningbo Hangzhou Bay Hospital, Ningbo, Zhejiang, China
| | - Yuquan Xie
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160# PuJian Road, Shanghai 200127, China
- Department of Cardiology, Ningbo Hangzhou Bay Hospital, Ningbo, Zhejiang, China
| | - Yong Zhou
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160# PuJian Road, Shanghai 200127, China
- Department of Cardiology, Punan Hospital, Pudong New District, Shanghai, China
| | - JianFeng Huang
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160# PuJian Road, Shanghai 200127, China
- Department of Cardiology, Dachang Hospital, Baoshan District, Shanghai, China
| | - Jun Pu
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160# PuJian Road, Shanghai 200127, China
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8
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Dong ZY, Shao W, Yuan Y, Lin L, Yu X, Cui L, Zhen Z, Gao L. Transseptal approach for catheter ablation of left-sided accessory pathways in children with Marfan syndrome: A case report. World J Clin Cases 2023; 11:2084-2090. [PMID: 36998966 PMCID: PMC10044966 DOI: 10.12998/wjcc.v11.i9.2084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/20/2023] [Accepted: 03/03/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Left-sided accessory pathways (APs) can be accessed with either a transaortic (TA) or transseptal approach (TS). For children with Marfan syndrome (MFS) who have aortic disease, the use of TA can aggravate the disease, making TS the best choice for these patients.
CASE SUMMARY A 10-year-old girl was hospitalized because of intermittent heart palpitations and chest tightness. She was diagnosed with MFS, supraventricular tachycardia, Wolff-Parkinson-White syndrome, and left-sided AP was detected by cardiac electrophysiological. Catheter ablation was successfully performed via TS under the guidance of the Ensite system. During the follow-up, no recurrence or complications occurred.
CONCLUSION The TS for catheter ablation of left-sided APs can be considered in children with MFS. Adequate evaluation and selection of the appropriate puncture site are particularly important.
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Affiliation(s)
- Zi-Yan Dong
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Wei Shao
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Yue Yuan
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Li Lin
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Xia Yu
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Lang Cui
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Zhen Zhen
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Lu Gao
- National Center for Children’s Health, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
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9
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Impact of Systematic Use of Intracardiac Ultrasound during Transseptal Catheterization in the Electrophysiology Laboratory. J Cardiovasc Dev Dis 2023; 10:jcdd10020062. [PMID: 36826558 PMCID: PMC9960297 DOI: 10.3390/jcdd10020062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/22/2023] [Accepted: 01/26/2023] [Indexed: 02/05/2023] Open
Abstract
AIMS To explore the impact of the use of intracardiac echocardiography (ICE) in the ablation of supraventricular arrhythmias requiring transseptal catheterization (TSC), whilst analyzing the reduction in periprocedural complications and complications specifically related to TSC. METHODS A retrospective multicenter study collecting data from consecutive atrial fibrillation (AF) and supraventricular ablation procedures that required TSC was performed in five Italian centers. Based on physician discretion, TSC was performed with or without ICE. Periprocedural complications, separating all complications from complications directly related to TSC, were collected. Independent predictors of periprocedural complications and TSC-related complications were investigated. RESULTS A total of 2181 TSCs were performed on 1862 patients at five Italian centers from 2006 to 2021, in 76% of cases by AF ablation and in 24% by ablation of other arrhythmias with a circuit in the left atrium. Overall, 1134 (52%) procedures were performed with ICE support and 1047 (48%) without ICE. A total of 67 (3.1%) complications were detected, 19 (1.7%) in the ICE group and 48 (4.6%) in the no ICE group, p < 0.001. A total of 42 (1.5%) complications directly related to TSC: 0.9% in the ICE group and 3.1% in the no ICE group (p < 0.001). The independent predictors of all complications were age (OR 1,02 95% C.I 1.00-1.05; p = 0.036), TSC with the use of ICE (OR 0.27 95% C.I 0.15-0.46; p < 0.001) and AF ablation (OR 2,25 95%C.I 1.05-4.83; p = 0.037). The independent predictors for TSC complications were age (OR 1.03 95% C.I 1.01-1.06; p = 0.013) and TSC with the use of ICE (OR 0.24 95% C.I 0.11-0.49; p < 0.001). CONCLUSIONS ICE reduced periprocedural and TSC-related complications during electrophysiological procedures for ablation of left atrial arrhythmias.
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10
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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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11
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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: 13] [Impact Index Per Article: 4.3] [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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12
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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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13
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Maisano F, Russo G, Tagliari AP, Gavazzoni M, Taramasso M. Left femoral vein access for transcatheter mitral valve interventions in unfavorable interatrial septal anatomy. Catheter Cardiovasc Interv 2021; 98:E971-E976. [PMID: 34533899 DOI: 10.1002/ccd.29950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 08/31/2021] [Indexed: 11/07/2022]
Abstract
Optimal transseptal puncture (TSP) position on the interatrial septum as well as proper catheter direction and maneuverability in the left atrium (LA) are key elements for successful mitral valve (MV) interventions. TSP is usually performed from the right femoral vein being more comfortable for the operator and easier to reach the fossa ovalis. In the cases reported, TSP was performed from left femoral vein (LFV) to improve delivery system maneuverability and trajectory inside the LA in the context of MV repair with MitraClip. According to this early experience, LFV approach might be considered as first choice or as an alternative solution in patients in whom a higher position of the delivery system relative to the mitral annulus is needed.
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Affiliation(s)
- Francesco Maisano
- Department of Cardiac Surgery, University Hospital San Raffaele, Milan, Italy
| | - Giulio Russo
- Fondazione Policlinico A. Gemelli, IRCSS, Università Cattolica del Sacro Cuore-Roma, Rome, Italy.,Department of Cardiology, University of Zurich, Zurich, Switzerland
| | - Ana Paula Tagliari
- Department of Cardiology, University of Zurich, Zurich, Switzerland.,Department of Cardiology and Cardiovascular Sciences, Postgraduate Program in Health Sciences: Cardiology and Cardiovascular Sciences-Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Mara Gavazzoni
- Department of Cardiology, University of Zurich, Zurich, Switzerland
| | - Maurizio Taramasso
- Department of Cardiovascular Surgery, HerzZentrum Hirslanden, Zurich, Switzerland
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14
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Braunwald E. Transseptal left heart catheterization: birth, death, and resurrection. Eur Heart J 2021; 42:2327-2328. [PMID: 34037716 DOI: 10.1093/eurheartj/ehab264] [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: 11/14/2022] Open
Affiliation(s)
- Eugene Braunwald
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School, Suite 7022, 60 Fenwood Road, Boston, MA 02115, USA
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15
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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: 12] [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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Study on the Curative Effect and Safety of Radiofrequency Catheter Ablation of Paroxysmal Atrial Fibrillation via Zero-Fluoroscopy Transseptal Puncture under the Dual Guidance of Electroanatomical Mapping and Intracardiac Echocardiography. Cardiol Res Pract 2021; 2021:5561574. [PMID: 34123417 PMCID: PMC8166467 DOI: 10.1155/2021/5561574] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/05/2021] [Indexed: 12/25/2022] Open
Abstract
Aims 3D electroanatomical mapping combined with intracardiac echocardiography- (EAM-ICE-) guided transseptal puncture has been proven safe and effective during the radiofrequency catheter ablation (RFCA) procedure used to treat paroxysmal atrial fibrillation (PAF). In this study, we aimed to compare the curative effect and safety of RFCA via F (fluoroscopy) and zero-fluoroscopy transseptal puncture guided by EAM-ICE in patients with PAF. Methods and Results A prospective study in which 110 patients with PAF were included and assigned to two groups was conducted. Fifty-five (50%) patients were enrolled in the EAM-ICE group, whereas the other 55 (50%) patients were enrolled in the F group. There were no significant differences in baseline characteristics between the two groups. The transseptal duration time was longer in the EAM-ICE group (19.8 ± 3.0 min vs. 8.6 ± 1.2 min, p ≤ 0.01); however, fluoroscopy was not used in the EAM-ICE group compared with the F group (0 mGy vs. 109.1 ± 57.9 mGy). Similarly, there was also no significant difference in the recurrence rate of atrial fibrillation between the EAM-ICE and F groups (25.5% vs. 18.2%, p=0.356). Conclusion RFCA via EAM-ICE-guided zero-fluoroscopy transseptal puncture in patients with PAF is safe and effective for long-term follow-up.
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17
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Elagha A, Othman Y, Darweesh R, Awadein G, Hashad A. Characterization of the interatrial septum by high-field cardiac MRI: a comparison with multi-slice computed tomography. Egypt Heart J 2020; 72:81. [PMID: 33180202 PMCID: PMC7661592 DOI: 10.1186/s43044-020-00109-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/14/2020] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Assessment of the interatrial septum (IAS) has become an attractive area of interest for a variety of important interventional procedures. Newer imaging modalities like multi-slice computed tomography (MSCT) and cardiac MRI (CMR) can provide higher resolution and wider field of view than echocardiography. Moreover, high-field (3-Tesla) CMR can even enhance spatial and temporal resolution.
The characteristics of the interatrial septum were retrospectively studied in 371 consecutive subjects (201 men, 31–73 years old) in whom MSCT was performed primarily for non-invasive evaluation of the coronary arteries. All subjects underwent both MSCT and MRI scans within 0–30 day’s interval. A 3D volume covering the whole heart was acquired across the heart with and without contrast enhancement. Also, patients underwent cardiac MSCT examinations using 64-row MSCT scanners.
Results
The mean scan time of MSCT was 10.4 ± 2.8 s and 9.7 ± 2.9 min for CMR. The mean length of IAS by CMR and CT was 39.65 ± 4.6 mm and 39.28 ± 4.7 mm, respectively. The mean maximal thickness of IAS by CMR and CT was 3.1 ± 0.97 mm and 3.15 ± 0.95 mm, respectively. The mean thickness of fossa ovalis by CMR and CT was 1.04 ± 0.36 mm and 1.04 ± 0.44 mm, respectively. The mean length of fossa ovalis by CMR and CT was 12.8 ± 3.7 mm and 12.8 ± 3.5 mm, respectively. Finally, the mean angle of IAS by CMR and CT was identical (155 ± 9.2°). Measurements of various morphological features of IAS showed no statistically significant difference between CMR and CT, with an excellent correlation and close relationship regarding IAS length, maximal IAS thickness, fossa ovalis thickness, fossa ovalis length, and IAS angle (r = 0.98, 0.98, 0.95, 0.96, and 0.92, respectively).
Conclusion
Whole-heart 3D acquisition at 3-T MRI using a free-breathing technique provides a valuable non-invasive imaging tool for excellent assessment of the interatrial septum—as compared to MSCT—that may have significant clinical implication for diagnostic purposes and therapeutic interventional procedures, as it may facilitate planning, improve outcome, and shorten its duration.
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18
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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: 25] [Impact Index Per Article: 5.0] [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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Fitzgerald JL, May AN, Mahmoodi E, Leitch J, Haqqani HM, Jackson N. Cryoballoon ablation from above, through a prosthetic patch atrial septal defect repair. HeartRhythm Case Rep 2020; 6:357-361. [PMID: 32577395 PMCID: PMC7300331 DOI: 10.1016/j.hrcr.2020.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- John L Fitzgerald
- Department of Cardiology, John Hunter Hospital, Newcastle, Australia
| | - Austin N May
- Department of Cardiology, John Hunter Hospital, Newcastle, Australia
| | - Ehsan Mahmoodi
- Department of Cardiology, John Hunter Hospital, Newcastle, Australia
| | - James Leitch
- Department of Cardiology, John Hunter Hospital, Newcastle, Australia
| | - Haris M Haqqani
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
| | - Nicholas Jackson
- Department of Cardiology, John Hunter Hospital, Newcastle, Australia.,School of Medicine, University of Newcastle, Newcastle, Australia
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