Division of Cardiology, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Texas Cardiac Arrhythmia Institute, Austin, Texas.
JACC Clin Electrophysiol. 2018 Aug;4(8):1011-1019. doi: 10.1016/j.jacep.2018.04.003. Epub 2018 May 30.
This study reports outcomes of bailout atrial balloon septoplasty (ABS) to overcome challenging left atrial (LA) access in patients undergoing atrial fibrillation (AF) ablation.
Transseptal puncture (TSP) and LA access for AF ablation can be challenging in patients with prior atrial septal surgery, percutaneous closure, or scarred septum due to multiple prior TSPs.
The study identified patients who underwent AF ablation at 2 ablation centers from 2011 to 2017 with challenging TSP in whom bailout percutaneous ABS was performed to allow LA access. Following TSP, the transseptal sheath could not be advanced to the LA despite multiple attempts or approaches including use of a stiff wire sequentially in the left and right pulmonary veins, use of a stiff pigtail exchange wire advanced in the LA or left ventricle, or sequential dilation with progressively larger diameter long dilators. ABS was performed using a noncompliant balloon (diameter 4 to 10 mm) advanced over a stiff wire deployed in the left superior pulmonary vein, allowing passage of the transseptal sheaths for completion of the AF ablation procedure.
Fifteen patients (mean age 54.4 ± 15.5 years, 9 women) with challenging TSP (7 patients with prior surgical ASD repair, 2 with percutaneous ASD closure devices, and 13 with ≥1 previous TSP) underwent bailout ABS for AF ablation. After TSP (radiofrequency assisted in 10 cases), ABS was successful and permitted access to the LA for ablation in all patients. Mean time required to perform ABS was 21.3 ± 19.4 min, and mean total procedure time was 241.1 ± 114.6 min (fluoroscopy time 62.0 ± 29.9 min). There were no procedural complications.
In patients undergoing AF ablation with difficult transseptal access due to scarred, surgically, or percutaneously repaired atrial septum, ABS is a safe and effective bailout strategy to obtain transseptal access.
本研究报告了在接受心房颤动（AF）消融治疗的患者中，使用 bailout 经房间隔气球扩张术（ABS）克服左心房（LA）入路困难的结果。
由于多次经房间隔穿刺（TSP）、既往房间隔手术、经皮封堵或瘢痕化的房间隔，经 TSP 穿刺和 LA 入路进行 AF 消融可能具有挑战性。
本研究从 2011 年至 2017 年在 2 个消融中心识别出接受 AF 消融的患者，这些患者在 TSP 过程中遇到困难，使用 bailout 经皮 ABS 来允许 LA 入路。尽管进行了多次尝试或采用了多种方法，包括在左右肺静脉中顺次使用硬导丝、在 LA 或左心室中顺次使用硬猪尾交换导丝、使用逐渐增大直径的长扩张器进行序贯扩张，但仍无法将经房间隔鞘管推进到 LA。使用非顺应性球囊（直径 4 至 10 毫米）在左肺上静脉中部署的硬导丝上推进，进行 ABS，允许经房间隔鞘管推进以完成 AF 消融程序。
15 名患者（平均年龄 54.4 ± 15.5 岁，9 名女性）在 TSP 过程中遇到挑战（7 名患者既往接受过 ASD 修补手术，2 名患者接受过 ASD 经皮封堵装置治疗，13 名患者有≥1 次 TSP），行 bailout ABS 用于 AF 消融。在 TSP 后（10 例中采用射频辅助），所有患者均成功进行 ABS，并允许进行 LA 消融。进行 ABS 所需的平均时间为 21.3 ± 19.4 分钟，总手术时间平均为 241.1 ± 114.6 分钟（透视时间 62.0 ± 29.9 分钟）。无手术并发症。
在因瘢痕、手术或经皮修补的房间隔而导致 TSP 入路困难的接受 AF 消融治疗的患者中，ABS 是一种安全有效的 bailout 策略，可获得经房间隔穿刺入路。
