Department of Medicine, Stanford University, Stanford, California.
Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Pacing Clin Electrophysiol. 2020 Jan;43(1):12-18. doi: 10.1111/pace.13841. Epub 2019 Dec 23.
Atrial fibrillation (AF) ablation requires access to the left atrium (LA) via transseptal puncture (TP). TP is traditionally performed with fluoroscopic guidance. Use of intracardiac echocardiography (ICE) and three-dimensional mapping allows for zero fluoroscopy TP.
To demonstrate safety and efficacy of zero fluoroscopy TP using multiple procedural approaches.
Patients undergoing AF ablation between January 2015 and November 2017 at five institutions were included. ICE and three-dimensional mapping were used for sheath positioning and TP. Variable technical approaches were used across centers including placement of J wire in the superior vena cava with ICE guidance followed by dragging down the transseptal sheath into the interatrial septum, or guiding the transseptal sheath directly to the interatrial septum by localizing the ablation catheter with three-dimensional mapping and replacing it with the transseptal needle once in position. In patients with pacemaker/implantable cardiac defibrillator leads, pre-/poststudy device interrogation was performed.
A total of 747 TPs were performed (646 patients, age 63.1 ± 13.1, 67.5% male, LA volume index 34.5 ± 15.8 mL/m , ejection fraction 57.7 ± 10.9%) with 100% success. No punctures required fluoroscopy. Two pericardial effusions, two pericardial tamponades requiring pericardiocentesis, and one transient ischemic attack were observed during the overall ablation procedure, with a total complication rate of 0.7%. There were no other periprocedural complications related to TP, including intrathoracic bleeding, stroke, or death both immediately following TP and within 30 days of the procedure. In patients with intracardiac devices, no device-related complications were observed.
TP can be safely and effectively performed without the need for fluoroscopy.
心房颤动 (AF) 消融术需要通过经房间隔穿刺 (TP) 进入左心房 (LA)。TP 传统上是在透视引导下进行的。使用心内超声心动图 (ICE) 和三维标测可以实现无射线透视 TP。
演示使用多种程序方法进行无射线透视 TP 的安全性和有效性。
在五个机构进行 AF 消融术的患者于 2015 年 1 月至 2017 年 11 月期间被纳入研究。ICE 和三维标测用于鞘管定位和 TP。各中心采用了不同的技术方法，包括在 ICE 引导下将 J 线置于上腔静脉中，然后将经房间隔鞘管向下拖动到房间隔，或者通过三维标测定位消融导管并将其直接引导至房间隔，一旦定位后再用经房间隔穿刺针取代。对于带有起搏器/植入式心脏除颤器导线的患者，在术前/术后进行设备检查。
共进行了 747 次 TP（646 例患者，年龄 63.1±13.1 岁，67.5%为男性，左心房容积指数 34.5±15.8 mL/m2，射血分数 57.7±10.9%），成功率为 100%。没有穿刺需要透视。在整个消融过程中，观察到 2 例心包积液、2 例心包填塞需要心包穿刺引流，以及 1 例短暂性脑缺血发作，总并发症发生率为 0.7%。在 TP 后即刻和手术 30 天内，没有其他与 TP 相关的围手术期并发症，包括胸腔内出血、中风或死亡。在带有心脏内装置的患者中，没有观察到与装置相关的并发症。
TP 可以安全有效地进行，无需透视。
