A Practical Method for Ablation Catheter Reintroduction into the Left Atrium via Prior Transseptal Puncture, without Radiation

  • Lingpin Pang The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, China
  • Song-wen Chen Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
  • Gen-qing Zhou Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
  • Yong Wei Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
  • Can Chen The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, China
  • Shi-an Huang Department of Cardiology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
  • Shao-wen Liu Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

Abstract

Background: We evaluated the feasibility and safety of reintroducing an ablation catheter (ABL) into the left atrium (LA) through a previously punctured interatrial septum under guidance of the show-catheter image-track function of the CARTO 3 3-dimensional (3D) electroanatomic
mapping system.

Methods: One hundred consecutive paroxysmal or persistent drug-refractory atrial fibrillation (AF) patients (men: 55; mean age, 64.7 ± 12.1 years) who had undergone 2 fluoroscopy-guided transseptal punctures and anatomical LA reconstruction under CARTO 3-guidance, and required ABL reinsertion into the LA during mapping or ablation, were included. They were randomized 1:1 to the show-catheter (reintroduction under the CARTO 3 show-catheter image-track function) or fluoroscopy group (reintroduction under conventional fluoroscopy).

Results: Although the reconstructed 3D anatomy map was displaced in 21/100 patients (21.0%), the ABL was successfully reintroduced in all patients. In the show-catheter and fluoroscopy groups, model displacement incidence (18% versus 24%), tachyarrhythmias (46.0% versus 52.0%), complications (2% versus 4%), and number of ABLs reintroduced into the LA (3.3 ± 0.8 versus 3.1 ± 0.9) were similar (all P > .05). The show-catheter group displayed shorter ABL reintroduction time (9.5 ± 5.5 s versus 156.4 ± 35.5 s, P < .01), ABL reintroduction X-ray exposure time (0 s versus 39.3 ± 13.8 s, P < .01), and total X-ray exposure time (4.1 ± 1.4 min versus 4.7 ± 0.8, P < .05).

Conclusion: During AF ablation, the catheter can be safely reintroduced into the LA, without additional fluoroscopy, under guidance of the CARTO 3 show-catheter image track function.

References

Alhajiri A, Ramadan MM, Senior R. 2014. Left atrial enlargement causing dysphagia and weight loss: a rare contraindication for catheter ablation therapy in a patient with complex atrial arrhythmia. Int J Cardiol 177:e111-12.

Bigelow AM, Smith G, Clark JM. 2014. Catheter ablation without fluoroscopy: Current techniques and future direction. J Atr Fibrillation 6:1066.

Chen S, Meng W, Sheng He D, et al. 2012. Blocking the pulmonary vein to left atrium conduction in addition to the entrance block enhances clinical efficacy in atrial fibrillation ablation. Pacing Clin Electrophysiol 35:524-31.

Chen S, Zhou G, Lu X, et al. 2019. The importance of identifying conduction breakthrough sites across the mitral isthmus by elaborate mapping for mitral isthmus linear ablation. Europace 21:950-60.

Christoph M, Wunderlich C, Moebius S, et al. 2015. Fluoroscopy integrated 3D mapping significantly reduces radiation exposure during ablation for a wide spectrum of cardiac arrhythmias. Europace 17:928-37.

Earley MJ. How to perform a transseptal puncture. 2009. Heart 95:85-92.

Gul EE, Baranchuk A, Glover BM. A guide to transseptal access. 2017. Can J Cardiol 33:544-7.

Hołda MK, Koziej M, Hołda J, et al. 2016. Anatomic characteristics of the mitral isthmus region: The left atrial appendage isthmus as a possible ablation target. Ann Anat 210:103-11.

Klimek-Piotrowska W, Hołda MK, Koziej M, et al. 2016. Clinical anatomy of the cavotricuspid isthmus and terminal crest. PLoS One 11(9):e0163383.

Klimek-Piotrowska W, Hołda MK, Koziej M, et al. 2016. Anatomy of the true interatrial septum for transseptal access to the left atrium. Ann Anat 205:60-4.

Meisinger QC, Stahl CM, Andre MP, Kinney TB, Newton IG. 2016. Radiation protection for the fluoroscopy operator and staff. AJR Am J Roentgenol 207:745-54.

Morady F, Oral H, Chugh A. 2009. Diagnosis and ablation of a typical atrial tachycardia and flutter complicating atrial fibrillation ablation. Heart Rhythm 6:S29-32.

O’Brien B, Zafar H, De Freitas S, Sharif F. 2017. Transseptal puncture - Review of anatomy, techniques, complications and challenges. Int J Cardiol 233:12-22.

Yuan Y, Long D, Sang C, Tao L, Dong J, Ma C. 2017. A practical guide for building a highway between atria during transseptal puncture without radiation. Anatol J Cardiol 17:470-3.

Published
2019-12-03
How to Cite
Pang, L., Chen, S.- wen, Zhou, G.- qing, Wei, Y., Chen, C., Huang, S.- an, & Liu, S.- wen. (2019). A Practical Method for Ablation Catheter Reintroduction into the Left Atrium via Prior Transseptal Puncture, without Radiation. The Heart Surgery Forum, 22(6), E470-E475. https://doi.org/10.1532/hsf.2621
Section
Articles

Most read articles by the same author(s)