Advertisement

Limiting left-sided catheter dwelling time using 3-D NavX to mark and reaccess the left atrium via prior transseptal puncture site

  • Anita G. Unnithan
  • Benjamin C. Dexter
  • Ian H. Law
  • Nicholas H. Von BergenEmail author
Article

Abstract

Introduction

Ablations requiring transseptal access to the left heart place patients at increased risk for stroke, bleeding, and post-procedural cognitive dysfunction and other complications. Diminishing left atrial catheter dwelling time may decrease these risks. 3-D NavX can be used to facilitate reaccess of transseptal puncture sites to allow catheter removal from the left atrium immediately after ablation, with reaccess through the prior transseptal site if required. Here, we describe the techniques employed and our experience using 3-D NavX to limit left atrial catheter dwelling time by marking and reaccess of the left atrium via the previously marked transseptal puncture site, a potentially radiation-free technique.

Methods

With the use of 3-D NavX, a right atrial geometry is created. The patent foramen ovale is marked by using a standard EP catheter, or the transseptal puncture site is marked using 3-D NavX by creating a unipolar electrode on the transseptal needle at the time of puncture and at the time of catheter withdrawal of the ablation catheter from the left atrium. Marking the access site allows the catheter to be removed from the left side of the heart immediately after the ablation. If reaccess to the left atrium is required, the previously marked transseptal site is used to navigate the ablation catheter to reaccess the left atrium. All patients <30 years who had undergone this technique were evaluated. Data gathered included patient demographics, need for and success of transseptal reaccess, left atrial catheter dwelling time, and complications.

Results

The transseptal site was marked by 3-D NavX in 54 patients. We were able to successfully reaccess the transseptal puncture site using 3-D guidance in all 10 patients where it was desired. In these 54 patients, the complication rate was low with one small post-procedural pulmonary embolism and one right bundle branch block. No other complications were noted. The median procedure time was 105 min (range 58–446 min), the median total fluoroscopic time for the entire procedure was 1.3 min (range 0.0–30.8 min), and the median left-sided catheter dwelling time was 21 min (range 6–112 min).

Conclusions

In our retrospective review, reaccess of transseptal puncture site was reproducible, and early removal of the catheter from the left side was without the need for repeat transseptal punctures. This technique decreases the time the catheter dwells in the left atrium, which could decrease risks such as clotting, bleeding, and cognitive dysfunction.

Keywords

Ablation 3-D mapping Transseptal 

Abbreviations

AET

Automatic ectopic tachycardia

AF

Atrial fibrillation

ASD

Atrial septal defect

AVRT

Atrioventricular reentrant tachycardia

EP

Electrophysiology

HRA

High right atrium

IART

Intra-atrial reentrant tachycardia

ICE

Intra-cardiac echocardiogram

LA

Left atrium

POCD

Post-procedural cognitive dysfunction

RA

Right atrium

RF

Radiofrequency

RVA

Right ventricular apex

TEE

Transesophageal echocardiogram

TSP

Transseptal puncture

VT

Ventricular tachycardia

References

  1. 1.
    Roelke, M., Smith, A. J., & Palacios, I. F. (1994). The technique and safety of transseptal left heart catheterization: the Massachusetts General Hospital experience with 1,279 procedures. Catheterization and Cardiovascular Diagnosis, 32, 332–339.PubMedCrossRefGoogle Scholar
  2. 2.
    De Ponti, R., Cappato, R., Curnis, A., Della Bella, P., Padeletti, L., Raviele, A., Santini, M., et al. (2006). Trans-septal catheterization in the electrophysiology laboratory: data from a multicenter survey spanning 12 years. Journal of the American College of Cardiology, 47, 1037–1042.PubMedCrossRefGoogle Scholar
  3. 3.
    Law, I. H., Fischbach, P. S., LeRoy, S., Lloyd, T. R., Rocchini, A. P., & Dick, M. (2001). Access to the left atrium for delivery of radiofrequency ablation in young patients: retrograde aortic vs transseptal approach. Pediatric Cardiology, 22(3), 204–209.PubMedCrossRefGoogle Scholar
  4. 4.
    Gaita, F., Caponi, D., Pianelli, M., et al. (2010). Radiofrequency catheter ablation of atrial fibrillation: a cause of silent thromboembolism? Magnetic resonance imaging assessment of cerebral thromboembolism in patients undergoing ablation of atrial fibrillation. Circulation, 122, 1667–1673.PubMedCrossRefGoogle Scholar
  5. 5.
    Medi, C., Evered, L., Silbert, B., et al. (2013). Subtle post-procedural cognitive dysfunction after atrial fibrillation ablation. Journal of the American College of Cardiology, 62, 531–539.PubMedCrossRefGoogle Scholar
  6. 6.
    Kugler, J. D., Danford, D. A., Houston, K. A., & Felix, G. (2002). Pediatric radiofrequency catheter ablation registry success, fluoroscopy time, and complication rate for supraventricular tachycardia: comparison of early and recent eras. Journal of Cardiovascular Electrophysiology, 13(4), 336–341.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Anita G. Unnithan
    • 1
  • Benjamin C. Dexter
    • 1
  • Ian H. Law
    • 1
  • Nicholas H. Von Bergen
    • 1
    Email author
  1. 1.Department of Pediatric CardiologyUniversity of Iowa Children’s HospitalIowa CityUSA

Personalised recommendations