Vol 28, No 5 (2021)
Original Article
Published online: 2020-01-21

open access

Page views 12696
Article views/downloads 1177
Get Citation

Connect on Social Media

Connect on Social Media

Transseptal puncture without fluoroscopy using a radiofrequency needle: A case series

Guram Imnadze12, Tarek Ajaj1, Hendrik Bante1, Christian Sohns2, Philipp Sommer2
Pubmed: 32037502
Cardiol J 2021;28(5):655-662.

Abstract

Background: The non-fluoroscopy approach with the use of a three-dimensional (3D) navigation system is increasingly recognized as a future technology in the treatment of arrhythmias. However, there are a limited number of articles published concerning transseptal puncture without the use of fluoroscopy.
Methods: Presented in this paper is the first series of patients (n = 10) that have undergone transseptal puncture without the use of fluoroscopy under transesophageal echocardiography control using a radiofrequency transseptal needle and a 3D navigation system.
Results: All patients were treated without complications. In 6 patients, re-pulmonary vein isolation was performed. In 5 cases, linear ablation of the left atrium for treatment of left atrial macro re-entry tachycardia was provided. In 2 patients, focal atrial tachycardia was treated, 1 patient underwent cavo tricuspidal isthmus (CTI) ablation and 1 patient, re-CTI ablation. The ablation of complex fragmented atrial electrograms was done in 2 patients. In 1 case, right atrial macro re-entry tachycardia was treated.
Conclusions: Transseptal puncture without using fluoroscopy is safe and effective when using a radiofrequency needle, a 3D navigation system and transesophageal echocardiography

Article available in PDF format

View PDF Download PDF file

References

  1. Gaita F, Guerra PG, Battaglia A, et al. The dream of near-zero X-rays ablation comes true. Eur Heart J. 2016; 37(36): 2749–2755.
  2. Álvarez M, Bertomeu-González V, Arcocha MFe, et al. investigators of the Spanish Multicenter Registry of Fluoroscopy-free Ablation. Nonfluoroscopic Catheter Ablation. Results From a Prospective Multicenter Registry. Rev Esp Cardiol (Engl Ed). 2017; 70(9): 699–705.
  3. Seizer P, Bucher V, Frische C, et al. Efficacy and safety of zero-fluoroscopy ablation for supraventricular tachycardias. Use of optional contact force measurement for zero-fluoroscopy ablation in a clinical routine setting. Herz. 2016; 41(3): 241–245.
  4. Gist K, Tigges C, Smith G, et al. Learning curve for zero-fluoroscopy catheter ablation of AVNRT: early versus late experience. Pacing Clin Electrophysiol. 2011; 34(3): 264–268.
  5. Zhang JQ, Yu RH, Liang JB, et al. Reconstruction left atrium and isolation pulmonary veins of paroxysmal atrial fibrillation using single contact force catheter with zero x-ray exposure: A CONSORT Study. Medicine (Baltimore). 2017; 96(41): e7726.
  6. Raju H, Whitaker J, Taylor C, et al. Electroanatomic Mapping and Transoesophageal Echocardiography for near Zero Fluoroscopy during Complex Left Atrial Ablation. Heart Lung Circ. 2016; 25(7): 652–660.
  7. Naksuk N, Asirvatham SJ, Naksuk N, et al. Iatrogenic atrial septal defect: reassurance or inquisitiveness. J Interv Card Electrophysiol. 2018; 52(2): 137–140.
  8. Ferguson JD, Helms A, Mangrum JM, et al. Catheter ablation of atrial fibrillation without fluoroscopy using intracardiac echocardiography and electroanatomic mapping. Circ Arrhythm Electrophysiol. 2009; 2(6): 611–619.
  9. Bulava A, Hanis J, Eisenberger M. Catheter ablation of atrial fibrillation using zero-fluoroscopy technique: a randomized trial. Pacing Clin Electrophysiol. 2015; 38(7): 797–806.
  10. O'Brien B, Balmforth DC, Hunter RJ, et al. Fluoroscopy-free AF ablation using transesophageal echocardiography and electroanatomical mapping technology. J Interv Card Electrophysiol. 2017; 50(3): 235–244.
  11. Sawhney V, Breitenstein A, Watts T, et al. A novel technique for performing transseptal puncture guided by a non-fluoroscopic 3D mapping system. Pacing Clin Electrophysiol. 2019; 42(1): 4–12.
  12. Tokuda M, Yamashita S, Matsuo S, et al. Radiofrequency needle for transseptal puncture is associated with lower incidence of thromboembolism during catheter ablation of atrial fibrillation: propensity score-matched analysis. Heart Vessels. 2018; 33(10): 1238–1244.
  13. Fromentin S, Sarrazin JF, Champagne J, et al. Prospective comparison between conventional transseptal puncture and transseptal needle puncture with radiofrequency energy. J Interv Card Electrophysiol. 2011; 31(3): 237–242.
  14. Smelley MP, Shah DP, Weisberg I, et al. Initial experience using a radiofrequency powered transseptal needle. J Cardiovasc Electrophysiol. 2010; 21(4): 423–427.
  15. Winkle RA, Mead RH, Engel G, et al. The use of a radiofrequency needle improves the safety and efficacy of transseptal puncture for atrial fibrillation ablation. Heart Rhythm. 2011; 8(9): 1411–1415.
  16. Feld GK, Tiongson J, Oshodi G. Particle formation and risk of embolization during transseptal catheterization: comparison of standard transseptal needles and a new radiofrequency transseptal needle. J Interv Card Electrophysiol. 2011; 30(1): 31–36.