Safety of a simplified electrophysiological method of transseptal puncture. A single center’s experience

摘要

Introduction Transseptal puncture (TSP) is a?part of many interventional cardiology procedures including left-sided arrhythmia catheter ablation, transvenous mitral commissurotomy, left atrial appendage occlusion and other catheter-based structural heart disease procedures [1]. Since 1959, when it was first performed [2], different techniques of TSP have been introduced. Guiding methods include fluoroscopy, pressure monitoring [3], intracardiac echocardiography (ICE) [4], transesophageal echocardiography (TEE) [3] and introduction of a?pigtail catheter into the aortic root [5]. Aim The purpose of this study was to verify the safety of a?simplified method of TSP for catheter ablation. Material and methods Data collection and patient population Six hundred and seventy-four consecutive electrophysiology (EP) procedures requiring TSP between November 2012 and July 2017 were retrospectively analyzed. Exclusion criteria included passing to the left atrium (LA) via a?patent foramen ovale. Patients were 51 ±15 years old and 36% were woman. Sixty-five percent suffered from atrial fibrillation (AF), 15% had an accessory pathway, 13% left-sided atrial tachycardia, flutter or extrasystole, 7% ventricular tachycardia, ventricular extrasystole or atrio-ventricular nodal reentry tachycardia (AVNRT). Twenty-nine percent of patients had prior TSP. Transseptal puncture procedure Since the first TSP was performed in our laboratory over 15 years ago it has been done with the same technique regardless of the operator. At the beginning of each procedure all tools are flushed with saline with heparin. A?diagnostic catheter is placed in the coronary sinus (CS) as deep as possible to mark the mitral valve plane. In the right anterior oblique (RAO) 30° view heart rotation in the horizontal plane is assessed (rotation of the apex and mitral valve to determine if the heart lies more horizontally or vertically). A?long sheath is introduced over a?guidewire into the superior vena cava (SVC). The guidewire is then removed and the puncture needle with a?protective stylet is introduced. Needles with very similar curvature were used in 99% of cases (TSNC by Cook Medical in 53% and BRK XS by St Jude Medical in 46%). In.