Intracardiac echocardiography-guided transseptal puncture for fluoroless catheter ablation of left-sided tachycardias
- PDF / 2,527,768 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 42 Downloads / 155 Views
Intracardiac echocardiography-guided transseptal puncture for fluoroless catheter ablation of left-sided tachycardias David Žižek 1
&
Bor Antolič 1 & Tine Prolič Kalinšek 2 & Jernej Štublar 1 & Nina Kajdič 1 & Matija Jelenc 2 & Matevž Jan 2
Received: 18 June 2020 / Accepted: 25 August 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Integration of intracardiac echocardiography (ICE) and 3D electroanatomic mapping (EAM) system allows transseptal punctures (TSP) without the use of fluoroscopy. Compared with fluoroscopy, ICE provides better visualization of the anatomy relevant to TSP and early recognition of complications. The aim was to evaluate efficacy and safety of entirely ICEguided TSPs in patients who underwent fluoroless catheter ablation of left-sided tachycardias. Methods Consecutive 524 adult and pediatric patients referred to our institution from July 2014 to December 2019 were analyzed. Patients with cardiac implantable electronic devices (CIEDs) were also included. All procedures were performed with ICE-guided TSP combined with 3D EAM. Adverse events following TSP and within 30 days of the procedure were analyzed. Results Altogether 949 TSPs (363 double punctures, 76.5%) were performed in 586 fluoroless ablation procedures: 451 (77%) were ablation of atrial fibrillation or atypical flutter, 75 (12.8%) of left-sided accessory pathway, 33 (5.6%) of ventricular tachycardia, and 27 (4.6%) of focal atrial tachycardia. Forty-six (7.8%) procedures were performed in pediatric population and 36 procedures (6.1%) in patients with CIED. Only 2 TSPs were unsuccessful (2/949, 0.2%). Overall procedural complication rate was 1.9% (11/586 procedures). There was only 1 TSP-related pericardial tamponade (2/949, 0.2%). In CIED patients, there was 1 lead dislocation following TSP. Conclusions Entirely ICE-guided TSPs for different left-sided tachycardias can be safely and effectively performed in adult and pediatric population without the use of fluoroscopy. However, caution is advised in CIED patients due to possible lead dislocation risk. Keywords Transseptal puncture . Intracardiac echocardiography . 3-dimensional systems . Fluoroless . Left-sided tachycardias
1 Introduction The transseptal puncture (TSP) is a routine procedure in electrophysiology to perform catheter ablation (CA) of atrial fibrillation (AF) and other left-sided arrhythmias including ventricular tachycardias (VT) [1]. Although fluoroscopic guidance to perform TSP is still the gold standard in clinical practice [2, 3], ultrasound-based Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10840-020-00858-z) contains supplementary material, which is available to authorized users. * David Žižek [email protected] 1
Cardiology Department, University Medical Centre Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia
2
Cardiovascular Surgery Department, University Medical Centre Ljubljana, Ljubljana, Slovenia
techniques including transesophageal echocardiography (TEE)
Data Loading...
