Feasibility and safety of a three-dimensional anatomic map–guided transseptal puncture for left-sided catheter ablation procedures. Issue 3 (4th January 2023)

• Record Type: Journal Article
• Authors: Bohnen, Marius; Minners, Jan; Eichenlaub, Martin; Weber, Reinhold; Allgeier, Hans-Jürgen; Jadidi, Amir; Neumann, Franz-Josef; Westermann, Dirk; Arentz, Thomas; Lehrmann, Heiko
• Is Part Of: Europace. Volume 25:Issue 3(2023)
• Page Start: 1126
• Page End: 1134
• Publication Date: 2023-01-04
• Subjects: Transseptal puncture technique -- 3D mapping system -- Catheter ablation -- Zero-fluoro -- Pulmonary vein isolation -- Atrial fibrillation; Arrhythmia -- Treatment -- Periodicals; Cardiac pacing -- Periodicals; Catheter ablation -- Periodicals; Heart -- Physiology -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1093/europace/euac262
• Languages: English
• ISSNs: 1099-5129

Abstract

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. Graphical Abstract: Graphical Abstract