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射频能量传递辅助下经房间隔穿刺的可行性、安全性和结果:一项前瞻性单中心研究。

Feasibility, safety, and outcome of a challenging transseptal puncture facilitated by radiofrequency energy delivery: a prospective single-centre study.

机构信息

Heart Rhythm Management Centre, UZ Brussel-VUB Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium.

出版信息

Europace. 2010 May;12(5):662-7. doi: 10.1093/europace/euq019. Epub 2010 Feb 23.

Abstract

AIMS

Although it has been shown that a transseptal (TS) puncture in the electrophysiology laboratory is associated with a high success and a low complication rate, this procedure remains challenging particularly in difficult septum anatomies (aneurismal septum and thick septum) and during repeat TS catheterization. Radiofrequency (RF) electrocautery current delivery through the TS needle has been shown to facilitate the TS puncture. The aim of this study was to verify prospectively the feasibility, safety, and outcome of RF energy delivery associated with the standard TS technique in patients undergoing a challenging TS puncture.

METHODS AND RESULTS

Over a 14-month period, 162 consecutive patients underwent left atrial (LA) arrhythmia ablation in our centre. Among them, we enrolled 18 patients who failed LA access after two TS puncture attempts. In these patients, an RF delivery through TS (RF-TS) needle approach was used to reach the LA. All 18 patients had a successful RF-TS at the first attempt. A transoesophageal echocardiography (TEE) guidance and fluoroscopy views were used in all patients. No acute complications were reported. There have been no clinical sequelae after 10 +/- 4 months of follow-up following the RF-TS approach. Challenging TS punctures were more frequent in repeat LA catheterization when compared with the first LA catheterization, respectively, in 35% (13 of 37) and 4% (5 of 125) of the patients.

CONCLUSION

Radiofrequency electrocautery delivery associated with the standard TS approach is a safe and reproducible technique to reach the left atrium, using the TEE guidance. This technique is helpful during repeat TS catheterization and in the presence of anatomical atrial septum abnormalities.

摘要

目的

尽管经房间隔(TS)穿刺在电生理实验室中已被证明具有较高的成功率和较低的并发症发生率,但该操作在某些特殊情况下(如房间隔解剖异常,包括房间隔瘤和较厚的房间隔)仍具有挑战性,尤其是在重复进行 TS 导管插入术时。通过 TS 针传递射频(RF)电流已被证明可促进 TS 穿刺。本研究旨在前瞻性验证在具有挑战性的 TS 穿刺中,联合标准 TS 技术应用 RF 能量传递的可行性、安全性和结果。

方法和结果

在 14 个月的时间里,我们中心对 162 例接受左心房(LA)心律失常消融的连续患者进行了研究。其中,我们纳入了 18 例经过两次 TS 穿刺尝试仍未能进入 LA 的患者。在这些患者中,使用 RF 传递 TS(RF-TS)针方法进入 LA。所有 18 例患者均在首次尝试时成功进行了 RF-TS。所有患者均采用经食管超声心动图(TEE)和透视视图进行引导。未报告任何急性并发症。在 RF-TS 方法治疗后 10 个月(4 个月至 16 个月)的随访中,未出现任何临床后遗症。与首次 LA 导管插入术相比,重复 LA 导管插入术时 TS 穿刺更具挑战性,分别有 35%(13/37)和 4%(5/125)的患者存在 TS 穿刺困难。

结论

在 TEE 引导下,联合标准 TS 方法应用 RF 电烧技术是一种安全且可重复的到达左心房的方法。该技术在重复进行 TS 导管插入术和存在解剖学上的房间隔异常时很有帮助。

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