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Atrial Transseptal Puncture (atrial + transseptal_puncture)

Distribution by Scientific Domains
Medical Sciences100%

Selected Abstracts

A Conservative Approach to Performing Transseptal Punctures Without the Use of Intracardiac Echocardiography: Stepwise Approach with Real-Time Video Clips

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 6 2007
ALAN CHENG M.D.
Atrial transseptal puncture as a means of accessing the left heart is a critical component of catheter ablation procedures for atrial fibrillation, left-sided accessory pathways, and access to the left ventricle in patients with certain types of prosthetic aortic valves. Although this technique has been performed successfully since the 1950s, severe and potentially life-threatening complications can still occur, including cardiac tamponade and/or death. Some have adopted the use of intracardiac echocardiography, but our laboratory and many others throughout the world have successfully relied on fluoroscopic imaging alone. The aim of this brief report is to describe in detail our technique for performing transseptal punctures during catheter ablation procedures for atrial fibrillation. We employ a similar approach when targeting left-sided accessory pathways, although only a single transseptal is performed in those cases. Utilizing a series of real-time video clips, we describe our technique of double transseptal puncture and illustrate in detail ways in which to avoid common pitfalls. [source]

Usefulness of Interatrial Conduction Time to Distinguish Between Focal Atrial Tachyarrhythmias Originating from the Superior Vena Cava and the Right Superior Pulmonary Vein

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 12 2008
KUAN-CHENG CHANG M.D.
Objective: Differentiation of the tachycardia originating from the superior vena cava (SVC) or the right superior pulmonary vein (RSPV) is limited by the similar surface P-wave morphology and intraatrial activation pattern during tachycardia. We sought to find a simple method to distinguish between the two tachycardias by analyzing the interatrial conduction time. Methods: Sixteen consecutive patients consisting of 8 with SVC tachycardia and the other 8 with RSPV tachycardia were studied. The interatrial conduction time from the high right atrium (HRA) to the distal coronary sinus (DCS) and the intraatrial conduction time from the HRA to the atrial electrogram at the His bundle region (HIS) were measured during the sinus beat (SR) and during the tachycardia-triggering ectopic atrial premature beat (APB). The differences of interatrial (,[HRA-DCS]SR-APB) and intraatrial (,[HRA-HIS]SR-APB) conduction time between SR and APB were then obtained. Results: The mean ,[HRA-DCS]SR-APB was 1.0 ± 5.2 ms (95% confident interval [CI],3.3,5.3 ms) in SVC tachycardia and 38.5 ± 8.8 ms (95% CI 31.1,45.9 ms) in RSPV tachycardia. The mean ,[HRA-HIS]SR-APB was 1.5 ± 5.3 ms (95% CI ,2.9,5.9 ms) in SVC tachycardia and 19.9 ± 12.0 ms (95% CI 9.9,29.9 ms) in RSPV tachycardia. The difference of ,[HRA-DCS]SR-APB between SVC and RSPV tachycardias was wider than that of ,[HRA-HIS]SR-APB (37.5 ± 9.3 ms vs. 18.4 ± 15.4 ms, P < 0.01). Conclusions: The wide difference of the interatrial conduction time ,[HRA-DCS]SR-APB between SVC and RSPV tachycardias is a useful parameter to distinguish the two tachycardias and may avoid unnecessary atrial transseptal puncture. [source]

Blunt atrial transseptal puncture using excimer laser in swine,

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 4 2007
Abdalla A. Elagha MD
Abstract Objectives: We describe a new approach that may enhance safety of atrial transseptal puncture using a commercially available laser catheter that is capable of perforation only when energized. We test this approach in swine. Background: Despite wide application, conventional needle transseptal puncture continues to risk inadvertent nontarget perforation and its consequences. Methods: We used a commercial excimer laser catheter (0.9-mm Clirpath, Spectranetics). Perforation force was compared in vitro with a conventional Brockenbrough needle. Eight swine underwent laser transseptal puncture under X-ray fluoroscopy steered using a variety of delivery catheters. Results: The 0.9-mm laser catheter traversed in vitro targets with reduced force compared with a Brockenbrough needle. In vitro, the laser catheter created holes that were 25,30% larger than the Brockenbrough needle. Laser puncture of the atrial septum was successful and accurate in all animals, evidenced by oximetry, pressure, angiography, and necropsy. The laser catheter was steered effectively using a modified Mullins introducer sheath and using two different deflectable guiding catheters. The mean procedure time was 15 ± 6 min, with an average 3.0 ± 0.8 sec of laser activation. There were no adverse sequelae after prolonged observation. Necropsy revealed discrete 0.9-mm holes in all septae. Conclusion: Laser puncture of the interatrial septum is feasible and safe in swine, using a blunt laser catheter that perforates tissues in a controlled fashion. © 2007 Wiley-Liss, Inc. [source]

Resynchronization with Left Ventricle Lead Placement Through the Foramen Ovale

CLINICAL CARDIOLOGY, Issue 6 2009
Christophe D'Ivernois MD
Left ventricle (LV) lead placement in a coronary sinus branch for cardiac resynchronization therapy may fail because of anatomical variants, phrenic nerve stimulation, and/or lead instability. We report a case of successful resynchronization from a lead inserted from the left subclavian vein and positioned through a patent foramen ovale (PFO). In conclusion, endocardial LV lead insertion through a PFO enables effective resynchronization delivery without the risks associated with a thoracotomy or atrial transseptal puncture. Copyright © 2009 Wiley Periodicals, Inc. [source]