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Safety of fluoroscopy-guided transseptal approach for ablation of left-sided arrhythmias.
Europace. 2017 Dec 01; 19(12):2023-2026.E

Abstract

Aims

The transseptal approach is used for left atrial access during the ablation of atrial fibrillation (AF) and other left-sided arrhythmia substrates. Transseptal puncture (TP) is commonly performed with fluoroscopic guidance, contrast injection, and pressure monitoring. In many centres, additional techniques [intracardiac echocardiography (ICE), transoesophageal echocardiography (TEE), radiofrequency needle] are used to facilitate TP but its use adds costs. In this retrospective study, we studied the safety and complication rate when TP was routinely done with fluoroscopic guidance, contrast injection, and pressure monitoring using ICE or TEE only in selected cases.

Methods and results

This study analysed 4690 consecutive TP performed between 2000 and 2015: 3408 (72.6%) were ablation of AF, left-sided atrial flutter, or left-sided atrial tachycardia (non-AP group); 1153 (24.6%) were ablation of left-sided accessory pathway, AP group; and 129 (2.8%) were ablation of ventricular tachycardia. Transseptal puncture was done under fluoroscopy, pressure monitoring, and commonly using contrast media injection. In 27 procedures, ICE or TEE was used to guide the TP. We found 34 tamponades (Tx) that required pericardial drainage of which 28 (0.59%) could possibly be TP related and six could not. The total complication rate for all Tx was 0.72%. A higher rate of tamponades was observed in the AF (non-AP) group than in the AP group (0.88 vs. 0.17%, P < 0.02). The highest rate of tamponades was registered during the operators 51-100 cases, 1.3%, and decreased to 0.4% in cases 101-200, P = 0.04.

Conclusion

TP can safely be done under fluoroscopy and pressure monitoring without routine use of additional techniques. With experience, operators should be able to further decrease complication rate.

Authors+Show Affiliations

Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28340160

Citation

Matoshvili, Zviad, et al. "Safety of Fluoroscopy-guided Transseptal Approach for Ablation of Left-sided Arrhythmias." Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups On Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology, vol. 19, no. 12, 2017, pp. 2023-2026.
Matoshvili Z, Bastani H, Bourke T, et al. Safety of fluoroscopy-guided transseptal approach for ablation of left-sided arrhythmias. Europace. 2017;19(12):2023-2026.
Matoshvili, Z., Bastani, H., Bourke, T., Braunschweig, F., Drca, N., Gudmundsson, K., Insulander, P., Jemtrén, A., Kennebäck, G., Saluveer, O., Schwieler, J., Tapanainen, J., Wredlert, C., & Jensen-Urstad, M. (2017). Safety of fluoroscopy-guided transseptal approach for ablation of left-sided arrhythmias. Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups On Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology, 19(12), 2023-2026. https://doi.org/10.1093/europace/euw432
Matoshvili Z, et al. Safety of Fluoroscopy-guided Transseptal Approach for Ablation of Left-sided Arrhythmias. Europace. 2017 Dec 1;19(12):2023-2026. PubMed PMID: 28340160.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Safety of fluoroscopy-guided transseptal approach for ablation of left-sided arrhythmias. AU - Matoshvili,Zviad, AU - Bastani,Hamid, AU - Bourke,Tara, AU - Braunschweig,Frieder, AU - Drca,Nikola, AU - Gudmundsson,Kristjan, AU - Insulander,Per, AU - Jemtrén,Anette, AU - Kennebäck,Göran, AU - Saluveer,Ott, AU - Schwieler,Jonas, AU - Tapanainen,Jari, AU - Wredlert,Christer, AU - Jensen-Urstad,Mats, PY - 2016/05/23/received PY - 2016/12/16/accepted PY - 2017/3/25/pubmed PY - 2018/7/31/medline PY - 2017/3/25/entrez KW - Ablation KW - Atrial fibrillation KW - Cardiac tamponade KW - Intracardiac echocardiography KW - Transseptal puncture SP - 2023 EP - 2026 JF - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology JO - Europace VL - 19 IS - 12 N2 - Aims: The transseptal approach is used for left atrial access during the ablation of atrial fibrillation (AF) and other left-sided arrhythmia substrates. Transseptal puncture (TP) is commonly performed with fluoroscopic guidance, contrast injection, and pressure monitoring. In many centres, additional techniques [intracardiac echocardiography (ICE), transoesophageal echocardiography (TEE), radiofrequency needle] are used to facilitate TP but its use adds costs. In this retrospective study, we studied the safety and complication rate when TP was routinely done with fluoroscopic guidance, contrast injection, and pressure monitoring using ICE or TEE only in selected cases. Methods and results: This study analysed 4690 consecutive TP performed between 2000 and 2015: 3408 (72.6%) were ablation of AF, left-sided atrial flutter, or left-sided atrial tachycardia (non-AP group); 1153 (24.6%) were ablation of left-sided accessory pathway, AP group; and 129 (2.8%) were ablation of ventricular tachycardia. Transseptal puncture was done under fluoroscopy, pressure monitoring, and commonly using contrast media injection. In 27 procedures, ICE or TEE was used to guide the TP. We found 34 tamponades (Tx) that required pericardial drainage of which 28 (0.59%) could possibly be TP related and six could not. The total complication rate for all Tx was 0.72%. A higher rate of tamponades was observed in the AF (non-AP) group than in the AP group (0.88 vs. 0.17%, P < 0.02). The highest rate of tamponades was registered during the operators 51-100 cases, 1.3%, and decreased to 0.4% in cases 101-200, P = 0.04. Conclusion: TP can safely be done under fluoroscopy and pressure monitoring without routine use of additional techniques. With experience, operators should be able to further decrease complication rate. SN - 1532-2092 UR - https://www.unboundmedicine.com/medline/citation/28340160/Safety_of_fluoroscopy_guided_transseptal_approach_for_ablation_of_left_sided_arrhythmias_ L2 - https://academic.oup.com/europace/article-lookup/doi/10.1093/europace/euw432 DB - PRIME DP - Unbound Medicine ER -