Lu Yi, Yuan Zhen, Liu Chunhui, Ma Shenghui, Shu Li, Cai Zhejun
Department of Cardiology Second Affiliated Hospital of Zhejiang University School of Medicine, Cardiovascular Key Lab of Zhejiang Province Hangzhou Zhejiang China.
J Arrhythm. 2023 Dec 12;40(1):118-123. doi: 10.1002/joa3.12975. eCollection 2024 Feb.
Transseptal puncture (TSP) is a crucial technique for catheter ablation of atrial fibrillation (AF). Although intracardiac echo (ICE) facilitates a safe and accurate TSP, it is not widely used in developing countries because of the expense. This study evaluated the efficiency and safety of a novel cardiac multidetector computed tomography (MDCT)-guided TSP during AF catheter ablation.
The study consisted of two cohorts. In the index cohort, TSP procedure was performed under the guidance of ICE, and we recorded the angulation of right anterior oblique of X-ray projection. In the validation cohort, we compared the efficiency and safety of TSP guided by MDCT-calculated angulation with propensity-score-matched patients who underwent TSP guided by ICE.
We included 50 patients in the index cohort, and the mean angles of interatrial septum (IAS) measured from MDCT and ICE were 34.8 ± 6.3 and 35.1 ± 6.5, respectively. In the validation cohort, 376 patients were enrolled in the MDCT-guided group and ICE-guided group. Both groups had 1 case of cardiac tamponade. The mean axial plane angle was 35.46 ± 6.17 degrees, which was not influenced by age, gender, BMI, and LA size, while a moderate positive linear correlation between EF and the axial plane angle ( = 0.14, = .006).
Cardiac MDCT can provide a clear vision of IAS orientation, and provide the appropriate RAO angle and height for TSP. The efficiency and safety of our MDCT-guided TSP were comparable to ICE-guided TSP, which may serve as an alternative method for TSP with ICE unavailable.
经房间隔穿刺（TSP）是心房颤动（AF）导管消融的关键技术。尽管心腔内超声（ICE）有助于安全准确地进行TSP，但由于费用问题，它在发展中国家并未广泛应用。本研究评估了一种新型心脏多排计算机断层扫描（MDCT）引导下的AF导管消融术中TSP的有效性和安全性。
本研究包括两个队列。在索引队列中，TSP手术在ICE引导下进行，我们记录了X线投照右前斜位的角度。在验证队列中，我们将MDCT计算角度引导下的TSP与倾向评分匹配的ICE引导下进行TSP的患者的有效性和安全性进行了比较。
索引队列纳入50例患者，MDCT和ICE测量的房间隔（IAS）平均角度分别为34.8±6.3和35.1±6.5。在验证队列中，MDCT引导组和ICE引导组分别纳入376例患者。两组均有1例心脏压塞。平均轴向平面角度为35.46±6.17度，不受年龄、性别、BMI和左心房大小影响，而射血分数（EF）与轴向平面角度呈中度正线性相关（r = 0.14，P = 0.006）。
心脏MDCT可以清晰显示IAS方向，并为TSP提供合适的右前斜位角度和高度。我们的MDCT引导下TSP的有效性和安全性与ICE引导下TSP相当，这可能是在无法使用ICE时TSP的替代方法。
