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Chokesuwattanaskul R, Ananwattanasuk T, Hughey AB, Stuart EA, Shah MM, Atreya AR, Chugh A, Bogun F, Crawford T, Pelosi F, Cunnane R, Ghanbari H, Latchamsetty R, Chung E, Saeed M, Ghannam M, Liang J, Oral H, Morady F, Jongnarangsin K. Three-dimensional-guided and ICE-guided transseptal puncture for cardiac ablations: A propensity score match study. J Cardiovasc Electrophysiol 2023; 34:382-388. [PMID: 36423239 PMCID: PMC10108269 DOI: 10.1111/jce.15756] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 10/05/2022] [Accepted: 10/20/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Transseptal puncture (TSP) is routinely performed for left atrial ablation procedures. The use of a three-dimensional (3D) mapping system or intracardiac echocardiography (ICE) is useful in localizing the fossa ovalis and reducing fluoroscopy use. We aimed to compare the safety and efficacy between 3D mapping system-guided TSP and ICE-guided TSP techniques. METHODS We conducted a prospective observational study of patients undergoing TSP for left atrial catheter ablation procedures (mostly atrial fibrillation ablation). Propensity scoring was used to match patients undergoing 3D-guided TSP with patients undergoing ICE-guided TSP. Logistic regression was used to compare the clinical data, procedural data, fluoroscopy time, success rate, and complications between the groups. RESULTS Sixty-five patients underwent 3D-guided TSP, and 151 propensity score-matched patients underwent ICE-guided TSP. The TSP success rate was 100% in both the 3D-guided and ICE-guided groups. Median needle time was 4.00 min (interquartile range [IQR]: 2.57-5.08) in patients with 3D-guided TSP compared to 4.02 min (IQR: 2.83-6.95) in those with ICE-guided TSP (p = .22). Mean fluoroscopy time was 0.2 min (IQR: 0.1-0.4) in patients with 3D-guided TSP compared to 1.2 min (IQR: 0.7-2.2) in those with ICE-guided TSP (p < .001). There were no complications related to TSP in both group. CONCLUSIONS Three-dimensional mapping-guided TSP is as safe and effective as ICE-guided TSP without additional cost.
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Affiliation(s)
- Ronpichai Chokesuwattanaskul
- Cardiovascular Medicine Department, Center of Excellence in Arrhythmia Research, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand.,Division of Cardiac Electrophysiology, University of Michigan Health Care, Ann Arbor, Michigan, USA
| | - Teetouch Ananwattanasuk
- Division of Cardiac Electrophysiology, University of Michigan Health Care, Ann Arbor, Michigan, USA.,Department of Internal Medicine, Cardiology Division, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | | | - Elizabeth A Stuart
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Muazzum M Shah
- Division of Cardiac Electrophysiology, University of Michigan Health Care, Ann Arbor, Michigan, USA
| | - Auras R Atreya
- Section of Cardiac Electrophysiology, AIG Institute of Cardiac Sciences and Research, Hyderabad, India
| | - Aman Chugh
- Division of Cardiac Electrophysiology, University of Michigan Health Care, Ann Arbor, Michigan, USA
| | - Frank Bogun
- Division of Cardiac Electrophysiology, University of Michigan Health Care, Ann Arbor, Michigan, USA
| | - Thomas Crawford
- Division of Cardiac Electrophysiology, University of Michigan Health Care, Ann Arbor, Michigan, USA
| | - Frank Pelosi
- Division of Cardiac Electrophysiology, University of Michigan Health Care, Ann Arbor, Michigan, USA
| | - Ryan Cunnane
- Division of Cardiac Electrophysiology, University of Michigan Health Care, Ann Arbor, Michigan, USA
| | - Hamid Ghanbari
- Division of Cardiac Electrophysiology, University of Michigan Health Care, Ann Arbor, Michigan, USA
| | - Rakesh Latchamsetty
- Division of Cardiac Electrophysiology, University of Michigan Health Care, Ann Arbor, Michigan, USA
| | - Eugene Chung
- Division of Cardiac Electrophysiology, University of Michigan Health Care, Ann Arbor, Michigan, USA
| | - Mohammed Saeed
- Division of Cardiac Electrophysiology, University of Michigan Health Care, Ann Arbor, Michigan, USA
| | - Michael Ghannam
- Division of Cardiac Electrophysiology, University of Michigan Health Care, Ann Arbor, Michigan, USA
| | - Jackson Liang
- Division of Cardiac Electrophysiology, University of Michigan Health Care, Ann Arbor, Michigan, USA
| | - Hakan Oral
- Division of Cardiac Electrophysiology, University of Michigan Health Care, Ann Arbor, Michigan, USA
| | - Fred Morady
- Division of Cardiac Electrophysiology, University of Michigan Health Care, Ann Arbor, Michigan, USA
| | - Krit Jongnarangsin
- Division of Cardiac Electrophysiology, University of Michigan Health Care, Ann Arbor, Michigan, USA
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Mori S, Nishii T, Tretter JT, Spicer DE, Hirata KI, Anderson RH. Demonstration of living anatomy clarifies the morphology of interatrial communications. Heart 2018; 104:2003-2009. [DOI: 10.1136/heartjnl-2018-313758] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 07/19/2018] [Accepted: 08/07/2018] [Indexed: 11/04/2022] Open
Abstract
Inferences made regarding the postnatal anatomy of the atrial septum still tend to be based on developmental evidence. Although atrial septation is a well-defined process, it is remarkably complex and remains poorly understood. It is now established, however, that the process involves the conjugation of several myocardial structures and mesenchymal tissues of both intracardiac and extracardiac origin. The resultant postnatal morphology is equally complex, evidenced by the fact that, in the normal heart, only the floor of the oval fossa, along with its anteroinferior muscular buttress, are true anatomical septums. In this regard, septums can be defined as partitions that can be removed without creating communications with the extracavitary space. The true septal components are surrounded by grooves, which themselves largely represent infolding of the atrial walls. These anatomical features can now accurately be revealed using virtual dissection of CT data sets. These images, when carefully reconstructed, demonstrated the anatomy with as much accuracy as when hearts are dissected in the autopsy room. Such virtual dissection, furthermore, shows the components as they are seen within the chest, thus facilitating understanding for those intending to undertake interventional therapeutic procedures. By preparing such images, we show the complexity of the normal atrial septum and its surrounds. We show that it is only defects within the oval fossa, or the much rarer vestibular defects, which can appropriately be illustrated in the context of a normally constructed heart.
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Squara F, Bres M, Baudouy D, Schouver ED, Moceri P, Ferrari E. Transesophageal echocardiography for the assessment of left atrial appendage thrombus: Study of the additional value of systematic real time 3D imaging after regular 2D evaluation. Echocardiography 2018; 35:474-480. [PMID: 29399868 DOI: 10.1111/echo.13813] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Two-dimensional transesophageal echocardiography (2DTEE) is currently validated for left atrial appendage (LAA) thrombus assessment but has some limitations. AIMS To evaluate the performance and interest of systematic real time three-dimensional transesophageal echocardiography (3DTEE) for LAA thrombus assessment, when performed after 2DTEE. METHODS AND RESULTS Consecutive patients undergoing TEE were prospectively included. LAA was first evaluated using 2DTEE, and patients were classified as "2D-NT" if no thrombus was found, "2D-T" in case of clear thrombus, or "2D-EQ" if equivocal. Then, 3DTEE of the LAA was performed and patients were similarly classified as "3D-NT," "3D-T," or "3D-EQ." Additional LAA CT scan was only performed if LAA thrombus was not clearly ruled out or confirmed by TEE. Additional value of 3DTEE after 2DTEE LAA evaluation was then assessed. We included 104 patients undergoing TEE. Agreement between 2DTEE and 3DTEE was very good for thrombus diagnosis (k = 0.936), but moderate for vacant LAA (k = 0.562) due to more frequent 2D-EQ than 3D-EQ (11.5% vs 2.9%; P = .016). 3DTEE allowed to refine the LAA status in 11 of 12 (91.7%) 2D-EQ patients: 10 3D-NT, 1 3D-T, and 1 3D-EQ. Coupling 3DTEE to 2DTEE permitted a definite LAA diagnosis in 103 of 104 (99%) vs 92 of 104 (88.5%) patients when 2DTEE was used alone (P = .002). Nine (8.7%) LAA thrombi were diagnosed, and 3 CT scan were performed. CONCLUSION 3DTEE of the LAA is more effective for thrombus assessment than 2DTEE. 3DTEE should be particularly considered in case of equivocal 2DTEE, as it allows to reach a definite LAA diagnosis in almost all of the patients.
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Affiliation(s)
- Fabien Squara
- Cardiology Department, Pasteur University Hospital, Nice, France
| | - Mikael Bres
- Cardiology Department, Pasteur University Hospital, Nice, France
| | - Delphine Baudouy
- Cardiology Department, Pasteur University Hospital, Nice, France
| | | | - Pamela Moceri
- Cardiology Department, Pasteur University Hospital, Nice, France
| | - Emile Ferrari
- Cardiology Department, Pasteur University Hospital, Nice, France
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Morais P, Vilaça JL, Ector J, D'hooge J, Tavares JMRS. Novel Solutions Applied in Transseptal Puncture: A Systematic Review. J Med Device 2017. [DOI: 10.1115/1.4035374] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Access to the left atrium is required for several minimally invasive cardiac interventions in the left heart. For this purpose, transseptal puncture (TSP) technique is often performed, perforating the atrial septum under fluoroscopic or/and ultrasound imaging guidance. Although this approach has been used for many years, complications/failures are not uncommon mainly in patients with abnormal atrial anatomy and repeated TSP. Thus, this study presents an overview of methods and techniques that have been proposed to increase the safety and feasibility of the TSP. A systematic review of literature was conducted through the analysis of the articles published between 2008 and 2015. The search was performed in PubMed, Scopus, and ISI Web of Knowledge using the expression “transseptal puncture.” A total of 354 articles were retrieved from the databases, and 64 articles were selected for this review. Moreover, these 64 articles were divided into four categories, namely: (1) incidence studies, (2) intraprocedural guidance techniques, (3) preprocedural planning methods, and (4) surgical instruments. A total of 36 articles focused on incidence studies, 24 articles suggested novel intraprocedural guidance techniques, 5 works focused on preprocedural planning strategies, and 21 works proposed surgical instruments. The novel 3D guidance techniques, radio-frequency surgical instruments, and pre-interventional planning approaches showed potential to overcome the main procedural limitations/complications, through the reduction of the intervention time, radiation, number of failures, and complications.
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Affiliation(s)
- Pedro Morais
- ICVS/3B's—PT Government Associate Laboratory, Braga/Guimarães 4710-057, Portugal
- Lab on Cardiovascular Imaging and Dynamics, KU Leuven, Leuven 3000, Belgium
- Instituto de Ciência e Inovação em Engenharia Mecânica e Engenharia Industrial, Faculdade de Engenharia, Universidade do Porto, Porto, Portugal
| | - João L. Vilaça
- ICVS/3B's—PT Government Associate Laboratory, Braga/Guimarães 4710-057, Portugal
- DIGARC—Polytechnic Institute of Cávado and Ave, Vila Frescainha S. Martinho Barcelos 4750-810, Portugal
| | - Joris Ector
- Lab on Cardiovascular Imaging & Dynamics, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jan D'hooge
- Lab on Cardiovascular Imaging & Dynamics, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - João Manuel R. S. Tavares
- Instituto de Ciência e Inovação em Engenharia Mecânica e Engenharia Industrial, Departamento de Engenharia Mecânica, Faculdade de Engenharia, Universidade do Porto, Rua Dr. Roberto Frias, s/n, Porto 4200-465, Portugal e-mail:
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Koektuerk B, Yorgun H, Koektuerk O, Turan CH, Gorr E, Horlitz M, Turan RG. Rotational Angiography Based Three-Dimensional Left Atrial Reconstruction: A New Approach for Transseptal Puncture. Cardiovasc Ther 2016; 34:49-56. [PMID: 26607305 DOI: 10.1111/1755-5922.12167] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AIM Rotational angiography is a well-known method for the three-dimensional (3-D) reconstruction of left atrium and pulmonary veins during left-sided atrial arrhythmia ablation procedures. In our study, we aimed to review our experience in transseptal puncture (TSP) using 3-D rotational angiography. METHODS We included a total of 271 patients who underwent atrial fibrillation ablation using cryoballoon. Rotational angiography was performed to get the three-dimensional left atrial and pulmonary vein reconstructions using cardiac C-arm computed tomography. The image reconstruction was made using the DynaCT Cardiac software (Siemens, Erlangen, Germany). RESULTS The mean age of the study population was 61 ± 10 years. The indications for left atrial arrhythmia ablation were paroxysmal AF in 140 patients (52%) and persistent AF patients in 131 (48%) patients. The success rate of TSP using only rotational guidance was (264/271 patients, 97.4%). In the remaining seven patients, transesophageal guidance was used after the initial attempt due to thick interatrial septum in five patients and difficult TSP due to abnormal anatomy and mild pericardial effusion in the remaining two patients. Mean fluoroscopy dosage of the rotational angiography was 4896.4 ± 825.3 μGym(2). The mean time beginning from femoral vein puncture to TSP was 12.3 ± 5.5 min. CONCLUSION TSP guided by rotational angiography is a safe and effective method. Our results indicate that integration of rotational angiographic images into the real-time fluoroscopy can guide the TSP during the procedure.
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Affiliation(s)
- Buelent Koektuerk
- Department of Cardiology/Electrophysiology, Witten/Herdecke University, Krankenhaus Porz am Rhein, Cologne, Germany
| | - Hikmet Yorgun
- Department of Cardiology/Electrophysiology, Witten/Herdecke University, Krankenhaus Porz am Rhein, Cologne, Germany
| | - Oezlem Koektuerk
- Department of Cardiology/Electrophysiology, Witten/Herdecke University, Krankenhaus Porz am Rhein, Cologne, Germany
| | - Cem H Turan
- Department of Cardiology/Electrophysiology, Witten/Herdecke University, Krankenhaus Porz am Rhein, Cologne, Germany
| | - Eduard Gorr
- Department of Cardiology/Electrophysiology, Witten/Herdecke University, Krankenhaus Porz am Rhein, Cologne, Germany
| | - Marc Horlitz
- Department of Cardiology/Electrophysiology, Witten/Herdecke University, Krankenhaus Porz am Rhein, Cologne, Germany
| | - Ramazan G Turan
- Department of Cardiology/Electrophysiology, Witten/Herdecke University, Krankenhaus Porz am Rhein, Cologne, Germany.,Division of Cardiology, Department of Internal Medicine, University Hospital of Rostock, Rostock, Germany
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6
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Mori S, Fukuzawa K, Takaya T, Takamine S, Ito T, Fujiwara S, Nishii T, Kono AK, Yoshida A, Hirata KI. Clinical cardiac structural anatomy reconstructed within the cardiac contour using multidetector-row computed tomography: Atrial septum and ventricular septum. Clin Anat 2015; 29:342-52. [DOI: 10.1002/ca.22546] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 03/08/2015] [Accepted: 03/17/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Shumpei Mori
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - Koji Fukuzawa
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - Tomofumi Takaya
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - Sachiko Takamine
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - Tatsuro Ito
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - Sei Fujiwara
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - Tatsuya Nishii
- Department of Radiology; Kobe University Graduate School of Medicine; Kobe Japan
| | - Atsushi K Kono
- Department of Radiology; Kobe University Graduate School of Medicine; Kobe Japan
| | - Akihiro Yoshida
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
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7
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SUN HUAN, WANG YANJING, ZHANG ZHENMING, LIU LIN, YANG PING. Predicting Interatrial Septum Rotation: Is the Position of the Heart or the Direction of the Coronary Sinus Reliable? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:514-9. [PMID: 25684336 DOI: 10.1111/pace.12590] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 12/09/2014] [Accepted: 01/04/2015] [Indexed: 12/26/2022]
Affiliation(s)
- HUAN SUN
- Department of Cardiology; China-Japan Union Hospital of Jilin University; Changchun China
| | - YANJING WANG
- Department of Radiology; China-Japan Union Hospital of Jilin University; Changchun China
| | - ZHENMING ZHANG
- Department of Radiology; China-Japan Union Hospital of Jilin University; Changchun China
| | - LIN LIU
- Department of Radiology; China-Japan Union Hospital of Jilin University; Changchun China
| | - PING YANG
- Department of Cardiology; China-Japan Union Hospital of Jilin University; Changchun China
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Guler E, Babur Guler G, Demir GG, Kizilirmak F, Gunes HM, Barutcu İ, Turkmen MM, Kilicaslan F. Evaluation of Adult versus Pediatric Transesophageal Echocardiography Probe Efficiency for Guiding Septal Puncture during Atrial Fibrillation Ablation. Echocardiography 2014; 32:1109-14. [DOI: 10.1111/echo.12821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Ekrem Guler
- Department of Cardiology; Faculty of Medicine; Medipol University Hospital; Istanbul Turkey
| | - Gamze Babur Guler
- Department of Cardiology; Faculty of Medicine; Medipol University Hospital; Istanbul Turkey
| | - Gultekin Gunhan Demir
- Department of Cardiology; Faculty of Medicine; Medipol University Hospital; Istanbul Turkey
| | - Filiz Kizilirmak
- Department of Cardiology; Faculty of Medicine; Medipol University Hospital; Istanbul Turkey
| | - Hacı Murat Gunes
- Department of Cardiology; Faculty of Medicine; Medipol University Hospital; Istanbul Turkey
| | - İrfan Barutcu
- Department of Cardiology; Faculty of Medicine; Medipol University Hospital; Istanbul Turkey
| | - Mehmet Muhsin Turkmen
- Department of Cardiology; Faculty of Medicine; Medipol University Hospital; Istanbul Turkey
| | - Fethi Kilicaslan
- Department of Cardiology; Faculty of Medicine; Medipol University Hospital; Istanbul Turkey
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Casella M, Russo E, Pizzamiglio F, Conti S, Al-Mohani G, Colombo D, Casula V, D Alessandra Y, Biagioli V, Carbucicchio C, Riva S, Fassini G, Moltrasio M, Tundo F, Zucchetti M, Majocchi B, Marino V, Forleo G, Santangeli P, Di Biase L, Dello Russo A, Natale A, Tondo C. The Growing Culture Of A Minimally Fluoroscopic Approach In Electrophysiology Lab. J Atr Fibrillation 2014; 7:1104. [PMID: 27957101 DOI: 10.4022/jafib.1104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 07/16/2014] [Accepted: 07/16/2014] [Indexed: 11/10/2022]
Abstract
Most of interventional procedures in cardiology are carried out under fluoroscopic imaging guidance. Besides other peri-interventional risks, radiation exposure should be considered for its stochastic (inducing malignancy) and deterministic effects on health (tissue reactions like erythema, hair loss and cataracts). In this article we analized the radiation risk from cardiovascular imaging to both patients and medical staff and discusses how customize the X-ray system and how to implement shielding measures in the cath lab. Finally, we reviewed the most recent developments and the latest findings in catheter navigation and 3D electronatomical mapping systems that may help to reduce patient and operator exposure.
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Affiliation(s)
- Michela Casella
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Eleonora Russo
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | | | - Sergio Conti
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Ghaliah Al-Mohani
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Daniele Colombo
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Victor Casula
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu
| | - Yuri D Alessandra
- Laboratory of immunology and functional genomics, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Viviana Biagioli
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Corrado Carbucicchio
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Stefania Riva
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Gaetano Fassini
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Massimo Moltrasio
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Fabrizio Tundo
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Martina Zucchetti
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Benedetta Majocchi
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Vittoria Marino
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Giovanni Forleo
- Division of Cardiology, Policlinico Tor Vergata, Rome, Italy
| | - Pasquale Santangeli
- Cardiac Arrhythmia Service, Stanford University School of Medicine, 300 Pasteur Drive H 2146, Stanford, CA, 94305, USA
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute at St David?s Medical Center, Austin, TX, USA
| | - Antonio Dello Russo
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Andrea Natale
- Cardiac Arrhythmia Service, Stanford University School of Medicine, 300 Pasteur Drive H 2146, Stanford, CA, 94305, USA
| | - Claudio Tondo
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
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Black D, Vettukattil J. Advanced echocardiographic imaging of the congenitally malformed heart. Curr Cardiol Rev 2014; 9:241-52. [PMID: 23228075 PMCID: PMC3780349 DOI: 10.2174/1573403x11309030008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 11/24/2012] [Indexed: 11/22/2022] Open
Abstract
There have been significant advancements in the ability of echocardiography to provide both morphological and functional information in children with congenitally malformed hearts. This progress has come through the development of improved technology such as matrix array probes and software which allows for the off line analysis of images to a high standard. This article focuses on these developments and discusses some newer concepts in advanced echocardiography such is multi-planar reformatting [MPR] and tissue motion annular displacement [TMAD]. Our aim is to discuss important aspects related to the quality and reproducibility of data, to review the most recent published data regarding advanced echocardiography in the malformed heart and to guide the reader to appropriate text for overcoming the technical challenges of using these methods. Many of the technical aspects of image acquisition and post processing have been discussed in recent reviews by the authors and we would urge readers to study these texts to gain a greater understanding [1]. The quality of the two dimensional image is paramount in both strain analysis and three dimensional echocardiography. An awareness of how to improve image quality is vital to acquiring accurate and usable data. Three dimensional echocardiography (3DE) is an attempt to visualise the dynamic morphology of the heart. Although published media is the basis for theoretical knowledge of how to practically acquire images, electronic media [eg.www.3dechocardiography.com] is the only way of visualising the advantages of this technology in real time. It is important to be aware of the limitations of this technology and that much of the data gleaned from using these methods is at a research stage and not yet in regular clinical practice.
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Affiliation(s)
- D Black
- Wessex Cardiothoracic unit, Congenital Cardiac Centre, Southampton University Hospital NHS Trust, UK
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Yao Y, Ding L, Chen W, Guo J, Bao J, Shi R, Huang W, Zhang S, Wong T. The training and learning process of transseptal puncture using a modified technique. Europace 2013; 15:1784-90. [DOI: 10.1093/europace/eut078] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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12
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Chierchia GB, Casado-Arroyo R, de Asmundis C, Rodriguez-Manero M, Sarkozy A, Conte G, Sieira J, Levinstein M, Baltogiannis G, di Giovanni G, Overeinder I, Ocello S, Rosas E, Isola F, Brugada P. Impact of transseptal puncture site on acute and mid-term outcomes during cryoballoon ablation: a comparison between anterior, medial and posterior transatrial access. Int J Cardiol 2013; 168:4098-102. [PMID: 23928339 DOI: 10.1016/j.ijcard.2013.07.079] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 05/22/2013] [Accepted: 07/07/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cryoballoon ablation (CBA) (Arctic Front, Medtronic, USA) has proven very effective in achieving pulmonary vein isolation (PVI). Different transseptal (TS) puncture sites might influence CBA procedure. The aim of the present study was to analyze the influence of different TS puncture sites (anterior, medial and posterior) on the acute and midterm outcomes of CBA in a series of patients undergoing PVI for drug resistant AF. METHODS AND RESULTS A total 103 patients (78 males, mean age: 57 ± 13 years) formed the study group. Transseptal punctures were performed in the anterior, medial and posterior portion of the FO in 41 (39.8%), 35 (34%) and 27 (26.2%) patients respectively. We found no statistical significant difference between the various sites of TS puncture in 1) the grade of PV occlusion (p = ns), the rate of PV isolation (p = ns), freedom from AF at a mean 12 month follow-up (p = ns) and complication rates (p = ns). Mean grade of occlusion was slightly lower in the RIPV when puncturing in the posterior FO but did not reach statistical significance. Mean procedural and fluoroscopy times were significantly lower when using the inner lumen mapping catheter (ILMC) (Achieve, Medtronic, USA) than the circular mapping catheter (CMC) (Lasso, Biosense Webster, California, USA) (107.24 mn vs 97.74 (p ≤ 0.001) and 25.7 mn vs 19.2 mn (p ≤ 0.001)). CONCLUSION Different sites of TS puncture on the horizontal axis of the FO (anterior, medial and posterior) did not influence grades of PV occlusion, rates of isolation, mid-term outcome and rates of complications during CB ablation.
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Affiliation(s)
- Gian-Battista Chierchia
- Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium; Modulo di Elettrofisiologia Cardiaca, Ospedale Santissima Trinità, Cagliari, Italy.
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Ottaviano L, Chierchia GB, Bregasi A, Bruno N, Antonelli A, Alsheraei A, Porrini A, Gronda E, Donatelli F, Duijnhower AL, Brugada P, Montenero AS. Cryoballoon ablation for atrial fibrillation guided by real-time three-dimensional transoesophageal echocardiography: a feasibility study. ACTA ACUST UNITED AC 2013; 15:944-50. [DOI: 10.1093/europace/eus431] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Maisano F, La Canna G, Latib A, Godino C, Denti P, Buzzatti N, Taramasso M, Cioni M, Giacomini A, Colombo A, Alfieri O. Transseptal access for MitraClip® procedures using surgical diathermy under echocardiographic guidance. EUROINTERVENTION 2012; 8:579-86. [DOI: 10.4244/eijv8i5a89] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Bayrak F, Chierchia GB, Namdar M, Yazaki Y, Sarkozy A, de Asmundis C, Muller-Burri SA, Rao J, Ricciardi D, Sorgente A, Brugada P. Added value of transoesophageal echocardiography during transseptal puncture performed by inexperienced operators. Europace 2011; 14:661-5. [PMID: 22117031 DOI: 10.1093/europace/eur366] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
AIMS Transseptal puncture (TP) appears to be safe in experienced hands; however, it can be associated with life-threatening complications. The aim of our study was to demonstrate the added value of routine use of transoesophageal echocardiography (TEE) for the correct positioning of the transseptal system in the fossa ovalis, thus potentially preventing complications during fluoroscopy-guided TP performed by inexperienced operators. METHODS AND RESULTS Two hundred and five patients undergoing pulmonary vein isolation procedure (PVI) for drug-resistant paroxysmal or persistent atrial fibrillation were prospectively included. When the operator (initially blinded to TEE) assumed that the transseptal system was in a correct position according to fluoroscopical landmarks, the latter was then checked with TEE unblinding the physician. If necessary, further refinement of the catheter position was performed. Refinement >10 mm, or in case of catheter pointing directly at the aortic root or posterior wall were considered as major repositioning. Thirty-four patients required major repositioning. Regression analysis revealed age (P: 0.0001, Wald: 12.9, 95% confidence interval: 1.04-1.16), left atrial diameter (P: 0.01, Wald: 6.6, 95% confidence interval: 1.04-1.34), previous PVI (P: 0.01, Wald: 6.3, 95% confidence interval: 1.31-8.76), and atrial septal thickness (P: 0.03, Wald: 4.5, 95% confidence interval: 1.05-3.4) as independent predictors of major revision with TEE. CONCLUSION Routine 2D TEE in addition to traditional fluoroscopic TP appears to be very useful to guide the TP assembly in a correct puncture position and thus, to avoid TP-related complications. However, further randomized prospective comparative studies are necessary to support these suggestions.
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Affiliation(s)
- Fatih Bayrak
- Heart Rhythm Management Center, UZ Brussels-VUB, Laarbeeklaan 101, Brussel 1090, Belgium.
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Kutyifa V, Merkely B, Nagy VK, Apor A, Zima E, Gellér L. Real-time three-dimensional transesophageal echocardiography-guided atrial fibrillation ablation procedure. Interv Med Appl Sci 2011. [DOI: 10.1556/imas.3.2011.3.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background
Real-time three-dimensional transesophageal echocardiography (RT 3D TEE) is a novel method providing high spatial and temporal resolution imaging of the heart. During pulmonary vein isolation procedures visualization of the atria, interatrial septum and the ablation catheter is of high importance to increase safety. RT 3D TEE might be a useful tool to guide left atrial ablations.
Case report
A 53-year-old man was referred to our hospital to undergo pulmonary vein isolation procedure for the treatment of symptomatic drug-refractory paroxysmal atrial fibrillation. The transseptal puncture was performed under RT 3D TEE-guidance with direct visualization of the interatrial septum and fossa ovalis. RT 3D TEE provided a three-dimensional view of the puncture with “tenting”-sign and the transseptal needle-fossa ovalis angle enhancing the manipulation of the ablation catheter within the left atrium. The ablation catheter was visualized and tracked during the procedure. No adverse events occurred during the procedure.
Conclusion
Our case report demonstrates the feasibility of RT 3D TEE-guided atrial fibrillation ablation procedures. Safety profile might be improved by the real-time direct view of fossa ovalis. Decrease in fluoroscopy time can be achieved by visualizing the ablation catheter during the procedure.
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Affiliation(s)
- Valentina Kutyifa
- 1 Heart Center, Semmelweis University, Budapest, Hungary
- 2 Heart Center, Semmelweis University, Városmajor utca 68, H-1122, Budapest, Hungary
| | - B. Merkely
- 1 Heart Center, Semmelweis University, Budapest, Hungary
| | - V. K. Nagy
- 1 Heart Center, Semmelweis University, Budapest, Hungary
| | - A. Apor
- 1 Heart Center, Semmelweis University, Budapest, Hungary
| | - E. Zima
- 1 Heart Center, Semmelweis University, Budapest, Hungary
| | - L. Gellér
- 1 Heart Center, Semmelweis University, Budapest, Hungary
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Localization of fossa ovalis and Brockenbrough needle prior to left atrial ablation using three-dimensional mapping with EnSite Fusion™. J Interv Card Electrophysiol 2010; 30:37-44. [DOI: 10.1007/s10840-010-9525-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2010] [Accepted: 10/21/2010] [Indexed: 10/18/2022]
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Stec S, Zaborska B, Sikora-Frac M, Kryński T, Kułakowski P. First experience with microprobe transoesophageal echocardiography in non-sedated adults undergoing atrial fibrillation ablation: feasibility study and comparison with intracardiac echocardiography. Europace 2010; 13:51-6. [PMID: 20880953 DOI: 10.1093/europace/euq349] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Imaging of the left atrium (LA) is mandatory during catheter ablation of atrial fibrillation (AF) and may be achieved by echocardiography. The aim of the present study was to assess the feasibility of using a recently released transoesophageal echocardiography (TEE) microprobe (micro-TEE) in non-sedated adult patients undergoing AF ablation and to directly compare this new technique with intracardiac echocardiography (ICE). METHODS AND RESULTS The study group consisted of 12 consecutive patients (8 males, mean age 49 ± 14 years) who underwent first radiofrequency AF ablation. All patients underwent standard TEE, computed tomography, intraprocedural micro-TEE, and ICE. The easiness of introducing the microprobe in the supine position in non-sedated patients in the electrophysiology laboratory, its tolerability, and quality of obtained images were assessed using a five-point scale. There were no problems with microprobe introduction and obtaining images for a mean of 54 ± 17 min. The microprobe was significantly better tolerated than the standard TEE probe (4.3 ± 0.5 vs. 3.4 ± 0.6 points, P < 0.01). The micro-TEE was scored as significantly better than ICE in the assessment of the LA and LA appendage (LAA) anatomy and function. Both techniques were very useful in guiding transseptal puncture, although micro-TEE images were ranked higher by an echocardiographer than by an electrophysiologist (tenting 4.8 ± 0.6 vs. 4.0 ± 0.6 points, P < 0.01), whereas ICE images were ranked equally excellent by both observers. CONCLUSION In non-sedated patients undergoing AF ablation, the micro-TEE can be used for the assessment of the LA, LAA, and pulmonary veins anatomy as well as the guidance of transseptal puncture.
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Affiliation(s)
- Sebastian Stec
- Division of Clinical Electrophysiology, Department of Cardiology, Grochowski Hospital, Postgraduate Medical School, Grenadierow 51/59 Street, 04-073 Warsaw, Poland.
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3D transesophageal echocardiography: a review of recent literature 2007–2009. Curr Opin Anaesthesiol 2010; 23:80-8. [DOI: 10.1097/aco.0b013e328334a6b3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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TZEIS STYLIANOS, ANDRIKOPOULOS GEORGE, DEISENHOFER ISABEL, HO SIEWYEN, THEODORAKIS GEORGE. Transseptal Catheterization: Considerations and Caveats. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:231-42. [DOI: 10.1111/j.1540-8159.2009.02598.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Transseptal fine needle aspiration of a large left atrial tumour. Heart Lung Circ 2009; 19:438-9. [PMID: 19656723 DOI: 10.1016/j.hlc.2009.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Revised: 06/19/2009] [Accepted: 06/20/2009] [Indexed: 11/20/2022]
Abstract
The diagnosis of cardiac tumours is often based on images without tissue diagnosis or tissue obtained at surgery. Percutaneous myocardial biopsy via a transvenous approach has been described in literatures but this technique is not feasible with left atrial tumours. We report a patient presenting with heart failure and left atrial tumour. The diagnosis of spindle cell neoplasm was established pre-operatively via successful transseptal fine needle aspiration of cells from a left atrial tumour. We believe this technique worth consideration to aid pre-surgery diagnosis.
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Latcu DG, Rinaldi JP, Saoudi N. Real-time three-dimensional transoesophageal echocardiography for diagnosis of left atrial appendage thrombus. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2009; 10:711-2. [DOI: 10.1093/ejechocard/jep076] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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de Asmundis C, Chierchia GB, Sarkozy A, Paparella G, Roos M, Capulzini L, Burri SAM, Yazaki Y, Brugada P. Novel trans-septal approach using a Safe Sept J-shaped guidewire in difficult left atrial access during atrial fibrillation ablation. Europace 2009; 11:657-9. [PMID: 19363051 DOI: 10.1093/europace/eup089] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Nowadays, trans-septal (TS) puncture is a relatively safe and straightforward procedure in experienced hands. However, in the presence of a thick, aneurysmatic or extremely elastic fossa ovalis crossing the septum might be challenging. We here describe the use of a novel guidewire that permits easy and safe 'over the wire' TS access during atrial fibrillation ablation.
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Affiliation(s)
- Carlo de Asmundis
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090 Brussels, Belgium.
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Eversull CS, Lin B, Irani AR, Quigley ML, Mourlas NJ, Hsia HH, Zei PC, Al-Ahmad A, Wang PJ. Direct Visualization of Cardiac Radiofrequency Ablation Lesions. J Cardiovasc Transl Res 2009; 2:198-201. [DOI: 10.1007/s12265-009-9094-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Accepted: 02/20/2009] [Indexed: 10/21/2022]
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Balzer J, Kelm M, Kühl HP. Real-time three-dimensional transoesophageal echocardiography for guidance of non-coronary interventions in the catheter laboratory. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2009; 10:341-9. [PMID: 19211569 DOI: 10.1093/ejechocard/jep006] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jan Balzer
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital RWTH Aachen, Germany
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