Safety and efficacy of zero fluoroscopy transseptal puncture with different approaches.

Abstract

INTRODUCTION: AF ablation requires access to the left atrium (LA) via transseptal puncture (TP). TP is traditionally performed with fluoroscopic guidance. Use of intracardiac echocardiography (ICE) and 3D mapping allows for zero fluoroscopy TP.OBJECTIVE: To demonstrate safety and efficacy of zero fluoroscopy TP using multiple procedural approaches.METHODS: Patients undergoing AF ablation between 1/2015 and 11/2017 at 5 institutions were included. ICE and 3D mapping were used for sheath positioning and TP. Variable technical approaches were used across centers including placement of J wire in the SVC with ICE guidance followed by dragging down the transseptal sheath into the interatrial septum; or guiding the transseptal sheath directly to the interatrial septum by localizing the ablation catheter with 3D mapping and replacing it with the transseptal needle once in position. In patients with PM/ICD leads, pre/post-study device interrogation was performed.RESULTS: A total of 747 transseptal punctures were performed (646 patients, age 63.1±13.1, 67.5% male, LA volume index 34.5±15.8ml/m2 , EF 57.7±10.9%) with 100% success. No punctures required fluoroscopy. 2 pericardial effusions, 2 pericardial tamponades requiring pericardiocentesis and 1 TIA were observed during the overall ablation procedure, with a total complication rate of 0.7%. There were no other periprocedural complications related to TP, including intrathoracic bleeding, stroke or death both immediately following TP and within 30 days of the procedure. In patients with intracardiac devices, no device-related complications were observed.CONCLUSION: Transseptal puncture can be safely and effectively performed without the need for fluoroscopy. This article is protected by copyright. All rights reserved.

View details for DOI 10.1111/pace.13841

View details for PubMedID 31736095