A simple method to localize transseptal puncture site during catheter ablation for atrial fibrillation

This study aims to describe a simple technique to safely localize appropriate TP site during atrial fibrillation (AF) ablation procedure. Inferior vena cava (IVC) angiography was performed at RAO 45°. The IVC, right atrium (RA), right-ventricular inflow tract, and right-ventricular outflow tract were sequentially visualized while the aorta was visualized as non-opacified filling defect. The appropriate TP site was in the middle of the RA, inferoposterior to the non-coronary aortic sinus (NCAS) and superoposterior to coronary sinus ostium. The spatial relationship of these structures was studied in 81 patients. The distance between optimal TP site and surrounding landmarks was analysed. Out of 393 consecutive TPs performed from August 2011 to January 2012, this technique was applied in 17 patients. Under RAO 45° on IVC angiography, an imaginary horizontal line was drawn across the middle point between NCAS and the top of the coronary sinus ostium. The line was divided into four quarters. In 78 (96%) patients, the optimal TP site was identified in the second one. In 94% (16/17) of the patients, all above-mentioned structures were clearly visualized and TP was successfully performed in all of them without complications. IVC angiography is a simple and safe technique which can facilitate TP in difficult cases. Optimal TP site can be easily identified on IVC angiography.

Source: European Journal of Heart Failure Supplements - June 25, 2015 Category: Cardiology Authors: Dong, J.-Z., Ning, M., Yu, R.-H., Long, D.-Y., Tang, R.-B., Sang, C.-H., Jiang, C.-X., Bai, R., Du, X., Nie, S.-P., Ma, C.-S. Tags: Articles Source Type: research