Europace Advance Access published online on October 3, 2008
Europace, doi:10.1093/europace/eun275
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TECHNICAL ISSUE
First experience with real-time three-dimensional transoesophageal echocardiography-guided transseptal in patients undergoing atrial fibrillation ablation
1 Cardiology Department, Heart Rhythm Management Center, UZ Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium; 2 Cardiology Department, Non-Invasive Cardiac Imaging Unit, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
Aims: Transseptal (TS) puncture during atrial fibrillation (AF) ablation is a relatively safe procedure in experienced hands. However, major and minor complications cannot be completely ruled out. Real-time three-dimensional transeosophageal echocardiography (RT 3D TEE) is a novel imaging technology that permits direct visualization of the fossa ovalis in a 3D perspective, thereby sensibly lowering the likelihood of potential adverse effects during TS. In our study, we describe the technique and assess the feasibility, advantages, and safety of this novel imaging method in guiding TS puncture in a series of consecutive patients undergoing AF ablation.
Methods and results: We performed TS puncture guided by RT 3D TEE under general anaesthesia in 24 consecutive patients (16 male, 55.4 ± 8.1 years) undergoing ablation for drug refractory AF. The fossa ovalis could clearly be seen and easily be distinguished from surrounding anatomical structures in all 24 patients. All punctures required a single attempt to access left atrium. Mean orientation of the needle hub when puncturing was 4.30 o'clock (ranging from 3 o'clock to 6.30 o'clock), and mean distances from the needle tip to the aortic and to the posterior wall were, respectively, 13.5 ± 7 and 35 ± 7.3 mm. Total fluoroscopic time was 120.6 ± 34 s. No major or minor complications were experienced.
Conclusion: Real-time three-dimensional transeosophageal is a very useful tool in guiding TS puncture in patients undergoing AF ablation with the invaluable advantage of the 3D direct visualization of the fossa ovalis. This permits fast and safe transatrial access with a single puncture attempt.
Key Words: Atrial fibrillation ablation, Real Time 3D echocardiography, Transseptal puncture
* Corresponding author. Tel: +32 2 477 6010; fax: +32 2 477 6840. E-mail address: jeanbaptiste.chierchia{at}uzbrussel.be
Manuscript submitted 21 June 2008. Accepted after revision 10 September 2008.
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