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HERO ID
7197978
Reference Type
Journal Article
Title
A novel technique for performing transseptal puncture guided by a non-fluoroscopic 3D mapping system
Author(s)
Sawhney, V; Sporton, S; Dhinoja, M; Breitenstein, A; Watts, T; Garcia, J; Finlay, M; Lowe, M; Hunter, R; Earley, MJ; Schilling, RJ; ,
Year
2019
Is Peer Reviewed?
1
Journal
Pacing and Clinical Electrophysiology
ISSN:
0147-8389
EISSN:
1540-8159
Publisher
WILEY
Location
HOBOKEN
Volume
42
Issue
1
Page Numbers
4-12
PMID
30397922
DOI
10.1111/pace.13541
Web of Science Id
WOS:000454955600002
Abstract
Background Transseptal puncture (TSP) is commonly performed under fluoroscopic guidance in left atrial ablation procedures. This exposes patients and healthcare professionals to deleterious ionizing radiation. We describe a novel technique for performing TSP non-fluoroscopically using a three-dimensional (3D) mapping system only. The safety and efficacy of this technique is compared to traditional fluoroscopy guided TSP. Methods Retrospective, single-center study of patients undergoing TSP for left atrial ablation. Those undergoing TSP using 3D mapping system alone (nonfluoroscopy group) were compared to those undergoing fluoroscopic guided TSP (Fluoroscopy group). Clinical, procedural data and complications were analyzed from a prospective registry. Results Twenty patients (32 TSPs) in the nonfluoroscopy (NF) group were compared to 14 patients (25 TSPs) in fluoroscopy (F) group. TSP success rates were similar across the groups (88% vs 96% in the NF and F groups, P = 0.97). In the NF group, there was one cardiac tamponade, two unsuccessful TSPs (previous cardiac surgery-required TOE guided TSP), and one patient required fluoroscopy on a background of CRTD device to avoid lead displacement. The mean fluoroscopy time and dose were significantly lower in the nonfluoroscopy group (0.75 +/- 0.50 vs 5.32 +/- 3.23 min, P < 0.001; 92.5 +/- 60.7 vs 394.3 +/- 182.7 cGy/cm(2), P < 0.001). Conclusion Our study shows that TSPs can be performed safely and effectively using this non-fluoroscopic novel technique in a select group of patients. Radiation exposure is reduced significantly without compromising patient safety. Larger studies are required to substantiate these results. Patients with cardiac implantable devices and previous cardiac surgery may pose a challenge to using this technique.
Keywords
3D mapping system; non-fluoroscopic approach; transseptal puncture
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