Transseptal catheterization of the native septum for atrial fibrillation ablation in presence of septal occluder device:
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CASE REPORTS
Transseptal catheterization of the native septum for atrial fibrillation ablation in presence of septal occluder device: a novel approach with real-time 3D transesophageal echocardiographic guidance Gianfranco Mitacchione 1
&
Antonio Curnis 2 & Giovanni B. Forleo 1
Received: 9 December 2019 / Accepted: 22 January 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Keywords Transseptal catheterization . Atrial septal occluder device . Atrial fibrillation ablation
1 Case presentation A 55-year-old male patient with normal left atrial size (39 mm) and 26-mm Amplatzer (Abbott, Plymouth, Minnesota) atrial septal occluder (ASO) device was referred for atrial fibrillation (AF) catheter ablation. During general anesthesia, Brockenbrough transseptal needle, sheath, and dilator (Swartz™ - SL1) entire system was withdrawn under fluoroscopic and real-time 3D transesophageal echocardiographic (TEE) guidance, engaging the posterior part of native interatrial septum, adjacent the ASO device. SafeSept® guidewire was used to cross the septum, and the whole system was
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10840-020-00703-3) contains supplementary material, which is available to authorized users. * Gianfranco Mitacchione [email protected] 1
Cardiology department, Luigi Sacco Hospital, University of Milan, Via G.B. Grassi 74, 20157 Milan, Italy
2
Cardiology department, Spedali Civili Hospital, University of Brescia, P.zza Spedali Civili 1, 20123 Brescia, Italy
advanced over the wire into the left atrium (Fig. 1a– d). The posterior transseptal (TSP) access allowed suitable catheter maneuverability for electroanatomic mapping and radiofrequency catheter ablation (Fig. 1e). TSP catheterization for AF ablation is described to be safe and feasible through native septum adjacent to the ASO device under intracardiac echocardiographic (ICE) guidance in a limited patient population with mild to moderate left atrial enlargement [1]. The case presented shows for the first time how real-time 3D-TEE guidance improves the safety and the efficacy of TSP catheterization in patients with normal atrial size and ASO device, providing a more precise localization of the native septum suitable for TSP puncture.
J Interv Card Electrophysiol Fig. 1 a–b 2D and 3D transesophageal echocardiographic view during transseptal catheterization. c Transseptal system engages the posterior part of native interatrial septum (fluoroscopic right anterior oblique projection). d Transseptal system cross the septum over SafeSept® guidewire (fluoroscopic left anterior oblique projection). e Posterior-anterior (left) and anterior-posterior (right) electroanatomic map after ablation
Compliance with ethical standards
References
Conflict of interest The authors declare that they have no conflict of interest.
1.
Santangeli P, Di Biase L, Burkhardt JD, Horton R, Sanchez J, Bailey S, et al. Transseptal access and atrial fibrillation ablation guided by intracardiac ech
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