Clinical EP Laboratory & Arrhythmia Center, Fuwai Hospital and Cardiovascular Institute, Peking Union Medical College (PUMC), Chinese Academy of Medical Sciences (CAMS), 167 Beilishi Road, Xicheng, Beijing 100037, China.
Europace. 2013 Dec;15(12):1784-90. doi: 10.1093/europace/eut078. Epub 2013 Aug 14.
As the transseptal (TS) puncture has become an integral part of many types of cardiac interventional procedures, its technique that was initial reported for measurement of left atrial pressure in 1950s, continue to evolve. Our laboratory adopted a modified technique which uses only coronary sinus catheter as the landmark to accomplishing TS punctures under fluoroscopy. The aim of this study is prospectively to evaluate the training and learning process for TS puncture guided by this modified technique.
Guided by the training protocol, TS puncture was performed in 120 consecutive patients by three trainees without previous personal experience in TS catheterization and one experienced trainer as a controller. We analysed the following parameters: one puncture success rate, total procedure time, fluoroscopic time, and radiation dose. The learning curve was analysed using curve-fitting methodology. The first attempt at TS crossing was successful in 74 (82%), a second attempt was successful in 11 (12%), and 5 patients failed to puncture the interatrial septal finally. The average starting process time was 4.1 ± 0.8 min, and the estimated mean learning plateau was 1.2 ± 0.2 min. The estimated mean learning rate for process time was 25 ± 3 cases. Important aspects of learning curve can be estimated by fitting inverse curves for TS puncture.
The study demonstrated that this technique was a simple, safe, economic, and effective approach for learning of TS puncture. Base on the statistical analysis, approximately 29 TS punctures will be needed for trainee to pass the steepest area of learning curve.
随着经房间隔（TS）穿刺已成为许多类型的心脏介入操作的一个组成部分，其最初于 20 世纪 50 年代用于测量左心房压力的技术仍在不断发展。我们的实验室采用了一种改良技术，仅使用冠状窦导管作为在透视下完成 TS 穿刺的标志。本研究旨在前瞻性评估该改良技术指导下的 TS 穿刺的培训和学习过程。
在培训方案的指导下，由三名没有 TS 导管经验的受训者和一名有经验的培训师作为控制者，对 120 例连续患者进行了 TS 穿刺。我们分析了以下参数：一次穿刺成功率、总手术时间、透视时间和辐射剂量。使用曲线拟合方法分析学习曲线。首次 TS 穿越尝试成功率为 74（82%），第二次尝试成功率为 11（12%），最终 5 例患者未能刺穿房间隔。平均起始过程时间为 4.1±0.8 分钟，估计平均学习平台时间为 1.2±0.2 分钟。过程时间的估计平均学习率为 25±3 例。通过拟合 TS 穿刺的逆曲线，可以估计学习曲线的重要方面。
该研究表明，该技术是一种简单、安全、经济和有效的 TS 穿刺学习方法。根据统计分析，大约需要 29 次 TS 穿刺，受训者才能通过学习曲线的最陡区域。
