Left atrial enlargement causing dysphagia and weight loss: a rare contraindication for catheter ablation therapy in a patient with complex atrial arrhythmia

A practical guide for building a highway between atria during transseptal puncture without radiation

OBJECTIVE

To investigate whether switching the ablation catheter between the right and left atria through transseptal puncture site can be accurately performed without fluoroscopy.

METHODS

Forty patients with persistent atrial fibrillation (mean age, 60.2±7.4 years; 65% males) got "2C3L" approach were randomized in a 1:1 ratio to undergo either crossing interatrial septum guided by fluoroscopy (trackless group) or crossing septum guided by track image that was mapped by Carto3 system (track group).

RESULTS

The three-dimensional image of the track could be mapped smoothly and shown clearly. No significant differences were found in the success rates between the two groups (100% vs. 100%, p>0.05). However, the procedure of crossing septum was completed without any fluoroscopy use in track group, which showed a shorter procedure time than trackless group (4±3 s vs. 20±10 s, p<0.01).

CONCLUSION

Visualizing the track passing through the puncture site using Carto3 system can guide the ablation catheter in safely crossing the intra-atrial septum quickly with zero fluoroscopy.