Skip to main content
SpringerLink
Log in

Fluoroscopy-free recrossing of the interatrial septum during left atrial ablation procedures

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Aim

The purpose of this is to evaluate the safety and feasibility of recrossing the interatrial septum in case of inadvertent loss of or need for repeated left atrial access using a simple electroanatomical landmark without the use of fluoroscopy.

Methods

Twenty-five consecutive patients undergoing pulmonary vein isolation (PVI) for paroxysmal (n = 12) or persistent (n = 13) atrial fibrillation ablation were included. All procedures were performed using an electroanatomical mapping system (Carto 3, Biosense Webster, Diamond Bar, USA). After fluoroscopy-guided double transseptal puncture and fast anatomical mapping of the left atrium, a reconstruction of the transseptal access was created by retracting the mapping catheter into the sheath to the level of the inferior vena cava. After completing the left sided ablation, both sheaths and catheters were withdrawn to the inferior vena cava. Recrossing was then attempted by fellows (EF) and experienced operators (EO) using the reconstruction of the transseptal access in a standard right anterior oblique (RAO) and left anterior oblique (LAO) projection without the use of fluoroscopy.

Results

Using the described technique, EP fellows and experienced operators could recross the interatrial septum without fluoroscopy in all patients. Median time needed for recrossing was 14 s (interquartile range (IQR) 7–20). Median recrossing times did not differ significantly between EF and EO (14 (IQR 8–26.5 s) versus 12 (IQR 6.5–17.5 s), p = 0.26). In five (20 %) procedures, recrossing was necessary during the procedure after intermittent mapping of the right atrium or inadvertent catheter dislodgment.

Conclusion

Adding a simple and fast anatomical reconstruction of the transseptal access to the standard left atrial mapping procedure allows for easy and fluoroscopy-free recrossing of the interatrial septum during atrial fibrillation ablation and further reduces radiation exposure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

AF:

Atrial fibrillation

BMI:

Body mass index

EF:

Electrophysiology fellow

EO:

Experienced operator

IQR:

Interquartile range

LA:

Left atrium

PVI:

Pulmonary vein isolation

PFO:

Patent foramen ovale

TSP:

Transseptal puncture

References

  1. Cappato, R., Calkins, H., Chen, S.-A., Davies, W., Iesaka, Y., Kalman, J., et al. (2010). Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circulation. Arrhythmia and Electrophysiology, 3(1), 32–38.

    Article  PubMed  Google Scholar 

  2. Calkins, H., Kuck, K. H., Cappato, R., Brugada, J., Camm, A. J., Chen, S.-A., et al. (2012). 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design: a report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation. Developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology (ESC) and the European Cardiac Arrhythmia Society (ECAS); and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). Endorsed by the governing bodies of the American College of Cardiology Foundation, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, the Asia Pacific Heart Rhythm Society, and the Heart Rhythm Society. Journal of Interventional Cardiac Electrophysiology, 33, 171–257.

  3. De Ponti, R., Cappato, R., Curnis, A., Della Bella, P., Padeletti, L., Raviele, A., et al. (2006). Transseptal catheterization in the electrophysiology laboratory: data from a multicenter survey spanning 12 years. Journal of the American College of Cardiology, 47(5), 1037–1042.

    Article  PubMed  Google Scholar 

  4. Tucker, K. J., Curtis, A. B., Murphy, J., Conti, J. B., Kazakis, D. J., Geiser, E. A., et al. (1996). Transesophageal echocardiographic guidance of transseptal left heart catheterization during radiofrequency ablation of left-sided accessory pathways in humans. Pacing and Clinical Electrophysiology: PACE, 19(3), 272–281.

    Article  CAS  PubMed  Google Scholar 

  5. Daoud, E. G., Kalbfleisch, S. J., & Hummel, J. D. (1999). Intracardiac echocardiography to guide transseptal left heart catheterization for radiofrequency catheter ablation. Journal of Cardiovascular Electrophysiology, 10(3), 358–363.

    Article  CAS  PubMed  Google Scholar 

  6. Hunter, R. J., Diab, I., Tayebjee, M., Richmond, L., Sporton, S., Earley, M. J., et al. (2011). Characterization of fractionated atrial electrograms critical for maintenance of atrial fibrillation a randomized, controlled trial of ablation strategies (the CFAE AF trial). Circulation. Arrhythmia and Electrophysiology, 4(5), 622–629.

    Article  PubMed  Google Scholar 

  7. O’Neill, M. D., Wright, M., Knecht, S., Jaïs, P., Hocini, M., Takahashi, Y., et al. (2009). Long-term follow-up of persistent atrial fibrillation ablation using termination as a procedural endpoint. European Heart Journal, 30(9), 1105–1112.

    Article  PubMed  Google Scholar 

  8. Camm, A. J., Lip, G. Y. H., De Caterina, R., Savelieva, I., Atar, D., Hohnloser, S. H., et al. (2012). 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. European Heart Journal, 33(21), 2719–2747.

    Article  PubMed  Google Scholar 

  9. Natarajan, M. K., Paul, N., Mercuri, M., Waller, E. J., Leipsic, J., Traboulsi, M., et al. (2013). Canadian Cardiovascular Society position statement on radiation exposure from cardiac imaging and interventional procedures. Canadian Journal of Cardiology, 29(11), 1361–1368.

    Article  PubMed  Google Scholar 

  10. Picano, E., Vañó, E., Rehani, M. M., Cuocolo, A., Mont, L., Bodi, V., et al. (2014). The appropriate and justified use of medical radiation in cardiovascular imaging: a position document of the ESC Associations of Cardiovascular Imaging, Percutaneous Cardiovascular Interventions and Electrophysiology. European Heart Journal, eht394.

  11. Yamada, T., McElderry, H. T., Epstein, A. E., Plumb, V. J., & Kay, G. N. (2007). One-puncture, double-transseptal catheterization manoeuvre in the catheter ablation of atrial fibrillation. Europace, 9(7), 487–489.

    Article  PubMed  Google Scholar 

  12. Sporton, S. C., Earley, M. J., Nathan, A. W., & Schilling, R. J. (2004). Electroanatomic versus fluoroscopic mapping for catheter ablation procedures: a prospective randomized study. Journal of Cardiovascular Electrophysiology, 15(3), 310–315.

    Article  PubMed  Google Scholar 

  13. Rotter, M., Takahashi, Y., Sanders, P., Haïssaguerre, M., Jaïs, P., Hsu, L.-F., et al. (2005). Reduction of fluoroscopy exposure and procedure duration during ablation of atrial fibrillation using a novel anatomical navigation system. European Heart Journal, 26(14), 1415–1421.

    Article  PubMed  Google Scholar 

  14. Nguyen, B., Merino, J., Shachar, Y., Estrada, A., Doiny, D., Castrejon, S., et al. (2013). Non-fluoroscopic transseptal catheterization during electrophysiology procedures using a remote magnetic navigation system. JAFIB: Journal of Atrial Fibrillation, 6(4), 6–9.

    Google Scholar 

  15. Lehrmann, H., Schneider, J., Jadidi, A. S., Park, C.-I., Schiebeling-Römer, J., Allgeier, J., et al. (2014). Transseptal access for left atrial ablation: the catheter-probing techniques are not without risk. Journal of Cardiovascular Electrophysiology, 25, 479–484.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiology/Electrophysiology, University Hospital Basel, 4031, Basel, Switzerland

    Nikola Pavlović, Tobias Reichlin, Michael Kühne, Sven Knecht, Stefan Osswald & Christian Sticherling

Authors
  1. Nikola Pavlović
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tobias Reichlin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael Kühne
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sven Knecht
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stefan Osswald
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christian Sticherling
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nikola Pavlović.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pavlović, N., Reichlin, T., Kühne, M. et al. Fluoroscopy-free recrossing of the interatrial septum during left atrial ablation procedures. J Interv Card Electrophysiol 41, 261–266 (2014). https://doi.org/10.1007/s10840-014-9952-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-014-9952-5

Keywords

Search

Navigation