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Transseptal Puncture (transseptal + puncture)
Kinds of Transseptal Puncture Selected AbstractsInteratrial Septum Thickness and Difficulty with Transseptal Puncture during Redo Catheter Ablation of Atrial FibrillationPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 12 2008DAVID R. TOMLINSON M.D. Background:Patients undergoing catheter ablation for atrial fibrillation (AF) frequently require redo procedures, but there are no data reporting interatrial septum thickness (IAS) and difficulty during repeat transseptal puncture (TSP). Methods:Patients undergoing two separate AF ablation procedures had preprocedural fossa ovalis (FO) thickness measured using transesophageal echocardiography (TEE). "Difficult" TSP was defined by two observers as requiring excessive force, or conversion to TEE guidance. Results:The study comprised 42 patients (37 male) with mean ± SD age 55 ± 9 years. Mean FO thickness was significantly greater at the time of redo TSP (2.2 ± 1.6 mm vs 2.6 ± 1.5 mm at redo, P = 0.03); however, this finding was limited to those who underwent initial dual transseptal sheath procedures, FO thickness 2.0 ± 1.5 mm and 2.5 ± 1.4 mm for TEE 1 and 2, respectively (P = 0.048). There was a trend for more frequent difficult redo TSP procedures, 7/42 (17%; 95% confidence interval [CI] 8,31) redo, versus 4/42 (10%; 95% CI 3,23) first TSP. On univariate analysis, FO thickness was not predictive of TSP difficulty; the only predictor of difficult redo TSP was diabetes. Conclusions:IAS thickness at the FO increased following catheter ablation of AF, yet on subgroup analysis this was limited to initial procedures utilizing dual transseptal sheaths. There was a trend toward more frequent difficulty during redo TSP, yet this was not associated with FO thickening. Diabetes may predispose to difficulty during redo TSP; this finding requires confirmation in a larger study population. [source] A Conservative Approach to Performing Transseptal Punctures Without the Use of Intracardiac Echocardiography: Stepwise Approach with Real-Time Video ClipsJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 6 2007ALAN 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] Radiofrequency Transseptal Catheter Electrode FracturePACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 6 2010ASHOK J. SHAH M.D. Transseptal puncture is performed using a long needle advanced from the femoral approach. A radiofrequency catheter has been developed that delivers a short burst of radiofrequency energy and creates a micro puncture in the interatrial septum. We describe a case in which the distal radiofrequency electrode broke and became embedded in the interatrial septum. (PACE 2010; 33:e57,e58) [source] Role of Echocardiography in Percutaneous Occlusion of the Left Atrial AppendageECHOCARDIOGRAPHY, Issue 4 2007Mráz M.D. Percutaneous occlusion of the left atrial appendage (LAA) is a modern alternative for the treatment of patients with atrial fibrillation (AF) and with a high risk of stroke who are not eligible for long-term anticoagulation therapy. Echocardiography plays a significant role in selecting patients, guiding the procedure, and in the postprocedural follow-up. Objectives and methods: To test the role of transesophagoeal echocardiography (TEE) and intracardiac echocardiography (ICE) in facilitating and shortening the procedure. Results: ICE represents a more convenient approach in patients who are not under generally anesthesia and helps to facilitate transseptal puncture. On the other hand, TEE, having the ability to rotate the image plane, helps to better determine the position of the occluder. Conclusions: Echocardiographic guidance of this procedure is essential. Which approach will be preferred will depend on the development of these two methods. [source] Clinical Experience with a Single Catheter for Mapping and Ablation of Pulmonary Vein OstiumJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 4 2009PAOLO DE FILIPPO M.D. Introduction: The aim of this single center study is to evaluate the safety and the efficacy of performing pulmonary vein isolation (PVI) using a single high-density mesh ablator (HDMA) catheter. Methods: A total of 17 consecutive patients with paroxysmal (10 patients) or persistent atrial fibrillation (7 patients) and no heart disease were enrolled. A single transseptal puncture was performed and the HDMA was placed at each PV ostium identified with anatomic and electrophysiological mapping. Pulsed radiofrequency (RF) energy was delivered at the targeted temperature of 58°C with maximum power of 80 watts. No other ablation system was utilized. The primary objective of the study was acute isolation of the targeted PV, and the secondary objective was clinical efficacy and safety of PVI with HDMA for atrial fibrillation (AF) prevention. Patients were followed at intervals of 1, 3, 6, and 12 months. Results: PVI was attempted with HDMA in 67/67 PVs. [Correction made after online publication October 27, 2008: PVs changed from 6/67 to 67/67] Acute success rate were: 100% (16/16) for left superior PV, 100% (16/16) for left inferior PV, 100% (17/17) for right superior PV, 100% (1/1) for left common trunk and 47% (8/17) for right inferior PV. Total procedure time was 200 ± 36 minutes (range 130,240 minutes) and total fluoroscopy time was 42 ± 18 minutes (range 23,75 minutes). During a mean follow-up of 11 ± 4 months, 64% of patients remained in sinus rhythm (8/10 paroxysmal AF and 3/7 for persistent AF). No complications occurred either acutely or at follow-up. Conclusions: PV isolation with HDMA is feasible and safe. The midterm efficacy in maintaining sinus rhythm is higher in paroxysmal than in persistent patients. [source] Usefulness of Interatrial Conduction Time to Distinguish Between Focal Atrial Tachyarrhythmias Originating from the Superior Vena Cava and the Right Superior Pulmonary VeinJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 12 2008KUAN-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] Periprocedural Anticoagulation for Atrial Fibrillation AblationJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 4 2008M. EYMAN MORTADA M.D. Background: Catheter ablation for atrial fibrillation (AF) can increase risk of left atrial (LA) thrombi and stroke. Optimal periprocedural anticoagulation has not been determined. Objective: We report the role of administering warfarin and aspirin without low molecular weight heparin in patients undergoing AF ablation. Methods: A total of 207 patients underwent ablation for AF. Transesophageal echocardiography (TEE) guided transseptal puncture and ruled out clot in the LA. After first puncture, the sheath was flushed with heparin (5,000 Units/mL). After second puncture, a bolus of 80 units/kg of heparin was given, followed by an infusion to maintain activated clotting time (ACT) around 300,350 seconds. Warfarin was stopped and aspirin was started (325 mg/day) 3 days preprocedure. Warfarin was restarted on the day of the procedure. Both medications were continued for 6 weeks postablation. Warfarin was continued for 6 months in patients with prior history of persistent or recurrent AF. Thirty-seven patients who showed smoke in the LA on TEE were given low molecular weight heparin postprocedure until international normalized ratio (INR) was therapeutic. Results: Thirty-two patients had persistent and 175 had paroxysmal AF; 87 were cardioverted during ablation. Two patients had transient ischemic attack (TIA) on the sixth and eighth days, respectively, following ablation, with complete recovery. Both had subtherapeutic INRs. Conclusion: In patients without demonstrable clot or smoke in the LA, starting aspirin 3 days prior and warfarin immediately post-radiofrequency ablation, without low molecular weight heparin, with meticulous anticoagulation during the procedure, appears to be a safe mode of anticoagulation. [source] A Conservative Approach to Performing Transseptal Punctures Without the Use of Intracardiac Echocardiography: Stepwise Approach with Real-Time Video ClipsJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 6 2007ALAN 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] Interatrial Septum Thickness and Difficulty with Transseptal Puncture during Redo Catheter Ablation of Atrial FibrillationPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 12 2008DAVID R. TOMLINSON M.D. Background:Patients undergoing catheter ablation for atrial fibrillation (AF) frequently require redo procedures, but there are no data reporting interatrial septum thickness (IAS) and difficulty during repeat transseptal puncture (TSP). Methods:Patients undergoing two separate AF ablation procedures had preprocedural fossa ovalis (FO) thickness measured using transesophageal echocardiography (TEE). "Difficult" TSP was defined by two observers as requiring excessive force, or conversion to TEE guidance. Results:The study comprised 42 patients (37 male) with mean ± SD age 55 ± 9 years. Mean FO thickness was significantly greater at the time of redo TSP (2.2 ± 1.6 mm vs 2.6 ± 1.5 mm at redo, P = 0.03); however, this finding was limited to those who underwent initial dual transseptal sheath procedures, FO thickness 2.0 ± 1.5 mm and 2.5 ± 1.4 mm for TEE 1 and 2, respectively (P = 0.048). There was a trend for more frequent difficult redo TSP procedures, 7/42 (17%; 95% confidence interval [CI] 8,31) redo, versus 4/42 (10%; 95% CI 3,23) first TSP. On univariate analysis, FO thickness was not predictive of TSP difficulty; the only predictor of difficult redo TSP was diabetes. Conclusions:IAS thickness at the FO increased following catheter ablation of AF, yet on subgroup analysis this was limited to initial procedures utilizing dual transseptal sheaths. There was a trend toward more frequent difficulty during redo TSP, yet this was not associated with FO thickening. Diabetes may predispose to difficulty during redo TSP; this finding requires confirmation in a larger study population. [source] Blunt atrial transseptal puncture using excimer laser in swine,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 4 2007Abdalla 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 OvaleCLINICAL CARDIOLOGY, Issue 6 2009Christophe 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] A Conservative Approach to Performing Transseptal Punctures Without the Use of Intracardiac Echocardiography: Stepwise Approach with Real-Time Video ClipsJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 6 2007ALAN 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] | ||||||||||