Access to the left atrium is required for several minimally invasive cardiac interventions in the left heart. For this purpose, transseptal puncture (TSP) technique is often performed, perforating the atrial septum under fluoroscopic or/and ultrasound imaging guidance. Although this approach has been used for many years, complications/failures are not uncommon mainly in patients with abnormal atrial anatomy and repeated TSP. Thus, this study presents an overview of methods and techniques that have been proposed to increase the safety and feasibility of the TSP. A systematic review of literature was conducted through the analysis of the articles published between 2008 and 2015. The search was performed in PubMed, Scopus, and ISI Web of Knowledge using the expression “transseptal puncture.” A total of 354 articles were retrieved from the databases, and 64 articles were selected for this review. Moreover, these 64 articles were divided into four categories, namely: (1) incidence studies, (2) intraprocedural guidance techniques, (3) preprocedural planning methods, and (4) surgical instruments. A total of 36 articles focused on incidence studies, 24 articles suggested novel intraprocedural guidance techniques, 5 works focused on preprocedural planning strategies, and 21 works proposed surgical instruments. The novel 3D guidance techniques, radio-frequency surgical instruments, and pre-interventional planning approaches showed potential to overcome the main procedural limitations/complications, through the reduction of the intervention time, radiation, number of failures, and complications.
Issue Section:
Review Article
References
1.
Babaliaros
, V. C.
, Green
, J. T.
, Lerakis
, S.
, Lloyd
, M.
, and Block
, P. C.
, 2008
, “Emerging Applications for Transseptal Left Heart Catheterization Old Techniques for New Procedures
,” J. Am. Coll. Cardiol.
, 51
(22
), pp. 2116
–2122
.2.
Matsumoto
, T.
, and Kar
, S.
, 2013
, “Latest Advances in Transseptal Structural Heart Interventions
,” Circul. J.
, 78
(8
), pp. 1782
–1790
.3.
Earley
, M. J.
, 2009
, “How to Perform a Transseptal Puncture
,” Heart
, 95
(1
), pp. 85
–92
.4.
Schwagten
, B.
, Jordaens
, L.
, Rivero-Ayerza
, M.
, Van Belle
, Y.
, Knops
, P.
, Thornton
, I.
, and Szili-Torok
, T.
, 2010
, “A Randomized Comparison of Transseptal and Transaortic Approaches for Magnetically Guided Ablation of Left-Sided Accessory Pathways
,” Pacing Clin. Electrophysiol.
, 33
(11
), pp. 1298
–1303
.5.
Ross
, J.
, 2008
, “Transseptal Left Heart Catheterization: A 50-Year Odyssey
,” J. Am. Coll. Cardiol.
, 51
(22
), pp. 2107
–2115
.6.
Yao
, Y.
, Ding
, L.
, Chen
, W.
, Guo
, J.
, Bao
, J.
, Shi
, R.
, Huang
, W.
, Zhang
, S.
, and Wong
, T.
, 2013
, “The Training and Learning Process of Transseptal Puncture Using a Modified Technique
,” Europace
, 15
(12), p. eut078
.7.
Hsu
, J. C.
, Badhwar
, N.
, Gerstenfeld
, E. P.
, Lee
, R. J.
, Mandyam
, M. C.
, Dewland
, T. A.
, Imburgia
, K. E.
, Hoffmayer
, K. S.
, Vedantham
, V.
, and Lee
, B. K.
, 2013
, “Randomized Trial of Conventional Transseptal Needle Versus Radiofrequency Energy Needle Puncture for Left Atrial Access (the TRAVERSE-LA Study)
,” J. Am. Heart Assoc.
, 2
(5
), p. e000428
.8.
Fromentin
, S.
, Sarrazin
, J.-F.
, Champagne
, J.
, Nault
, I.
, Philippon
, F.
, Molin
, F.
, Blier
, L.
, and O'Hara
, G.
, 2011
, “Prospective Comparison Between Conventional Transseptal Puncture and Transseptal Needle Puncture With Radiofrequency Energy
,” J. Interventional Card. Electrophysiol.
, 31
(3
), pp. 237
–242
.9.
Mitchell-Heggs
, L.
, Lellouche
, N.
, Deal
, L.
, Elbaz
, N.
, Hamdaoui
, B.
, Castanié
, J.-B.
, Dubois-Randé
, J.-L.
, Guéret
, P.
, and Lim
, P.
, 2010
, “Transseptal Puncture Using Minimally Invasive Echocardiography During Atrial Fibrillation Ablation
,” Europace
, 12
(10
), pp. 1435
–1438
.10.
Lakkireddy
, D.
, Rangisetty
, U.
, Prasad
, S.
, Verma
, A.
, Biria
, M.
, Berenbom
, L.
, Pimentel
, R.
, Emert
, M.
, Rosamond
, T.
, and Fahmy
, T.
, 2008
, “Intracardiac Echo-Guided Radiofrequency Catheter Ablation of Atrial Fibrillation in Patients With Atrial Septal Defect or Patent Foramen Ovale Repair: A Feasibility, Safety, and Efficacy Study
,” J. Cardiovasc. Electrophysiol.
, 19
(11
), pp. 1137
–1142
.11.
Lim
, H. E.
, Pak
, H.-N.
, Tse
, H.-F.
, Lau
, C.-P.
, Hwang
, C.
, and Kim
, Y.-H.
, 2009
, “Catheter Ablation of Atrial Fibrillation Via Superior Approach in Patients With Interruption of the Inferior Vena Cava
,” Heart Rhythm
, 6
(2
), pp. 174
–179
.12.
Ho
, S. Y.
, McCarthy
, K. P.
, and Faletra
, F. F.
, 2011
, “Anatomy of the Left Atrium for Interventional Echocardiography
,” Eur. Heart J.-Cardiovasc. Imaging
, 12
(10
), pp. i11
–i15
.13.
Knecht
, S.
, Wright
, M.
, Lellouche
, N.
, Nault
, I.
, Matsuo
, S.
, O'Neill
, M. D.
, Lomas
, O.
, Deplagne
, A.
, Bordachar
, P.
, and Sacher
, F.
, 2008
, “Impact of a Patent Foramen Ovale on Paroxysmal Atrial Fibrillation Ablation
,” J. Cardiovasc. Electrophysiol.
, 19
(12
), pp. 1236
–1241
.14.
Moher
, D.
, Liberati
, A.
, Tetzlaff
, J.
, Altman
, D. G.
, and Group
, P.
, 2010
, “Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement
,” Int. J. Surg.
, 8
(5
), pp. 336
–341
.15.
von Alvensleben
, J. C.
, Dick
, M.
, II, Bradley
, D. J.
, and LaPage
, M. J.
, 2014
, “Transseptal Access in Pediatric and Congenital Electrophysiology Procedures: Defining Risk
,” J. Interventional Card. Electrophysiol.
, 41
(3
), pp. 273
–277
.16.
Elayi
, C. S.
, Gurley
, J. C.
, Di Sessa
, T. G.
, and Kakavand
, B.
, 2011
, “Surgical Electrocautery Facilitated Transseptal Puncture in Children
,” Pacing Clin. Electrophysiol.
, 34
(7
), pp. 827
–831
.17.
Clark
, J.
, Bockoven
, J.
, Lane
, J.
, Patel
, C.
, and Smith
, G.
, 2008
, “Use of Three-Dimensional Catheter Guidance and Trans-Esophageal Echocardiography to Eliminate Fluoroscopy in Catheter Ablation of Left-Sided Accessory Pathways
,” Pacing Clin. Electrophysiol.
, 31
(3
), pp. 283
–289
.18.
Jauvert
, G.
, Grimard
, C.
, Lazarus
, A.
, and Alonso
, C.
, 2014
, “Comparison of a Radiofrequency Powered Flexible Needle With a Classic Rigid Brockenbrough Needle for Transseptal Punctures in Terms of Safety and Efficacy
,” Heart, Lung Circ.
, 24
(2), pp. 173–179.19.
Bayrak
, F.
, Chierchia
, G.-B.
, Namdar
, M.
, Yazaki
, Y.
, Sarkozy
, A.
, de Asmundis
, C.
, Muller-Burri
, S. A.
, Rao
, J.
, Ricciardi
, D.
, and Sorgente
, A.
, 2012
, “Added Value of Transesophageal Echocardiography During Transseptal Puncture Performed by Inexperienced Operators
,” Europace
, 14
(5
), pp. 661
–665
.20.
Yao
, Y.
, Guo
, J.
, Ding
, L.
, Bao
, J.
, Huang
, W.
, Shi
, R.
, Wu
, L.
, and Zhang
, S.
, 2012
, “Improved Approach to Atrial Septum Puncture: Experience in 539 Cases
,” Chin. Med. J.
, 125
(6
), pp. 1179
–1181
.21.
Wadehra
, V.
, Buxton
, A. E.
, Antoniadis
, A. P.
, McCready
, J. W.
, Redpath
, C. J.
, Segal
, O. R.
, Rowland
, E.
, Lowe
, M. D.
, Lambiase
, P. D.
, and Chow
, A. W.
, 2011
, “The Use of a Novel Nitinol Guidewire to Facilitate Transseptal Puncture and Left Atrial Catheterization for Catheter Ablation Procedures
,” Europace
, 13
(10), p. eur155
.22.
Wieczorek
, M.
, Hoeltgen
, R.
, Akin
, E.
, and Salili
, A. R.
, 2010
, “Use of a Novel Needle Wire in Patients Undergoing Transseptal Puncture Associated With Severe Septal Tenting
,” J. Interventional Card. Electrophysiol.
, 27
(1
), pp. 9
–13
.23.
Mulder
, A. A.
, Balt
, J. C.
, Wijffels
, M. C.
, Wever
, E. F.
, and Boersma
, L. V.
, 2012
, “Safety of Pulmonary Vein Isolation and Left Atrial Complex Fractionated Atrial Electrograms Ablation for Atrial Fibrillation With Phased Radiofrequency Energy and Multi-Electrode Catheters
,” Europace
, 14
(10
), pp. 1433
–1440
.24.
Tang
, R.-B.
, Dong
, J.-Z.
, Long
, D.-Y.
, Yu
, R.-H.
, Liu
, X.-P.
, Cheng
, Y.-L.
, Sang
, C.-H.
, Ning
, M.
, Jiang
, C.-X.
, and Avula
, U. M. R.
, 2014
, “Incidence and Clinical Characteristics of Transient ST-T Elevation During Transseptal Catheterization for Atrial Fibrillation Ablation
,” Europace
, 17
(4), p. euu278
.25.
Zellerhoff
, S.
, Daly
, M.
, Lim
, H. S.
, Denis
, A.
, Komatsu
, Y.
, Jesel
, L.
, Derval
, N.
, Sacher
, F.
, Cochet
, H.
, and Knecht
, S.
, 2014
, “Pulmonary Vein Isolation Using a Circular, Open Irrigated Mapping and Ablation Catheter (nMARQ): A Report on Feasibility and Efficacy
,” Europace
, 16
(9), p. euu133
.26.
Miyazaki
, S.
, Shah
, A. J.
, Nault
, I.
, Wright
, M.
, Jadidi
, A. S.
, Forclaz
, A.
, Liu
, X.
, Linton
, N.
, Xhaet
, O.
, and Rivard
, L.
, 2011
, “Impact of Patent Foramen Ovale on Left Atrial Linear Lesions in the Context of Atrial Fibrillation Ablation
,” J. Cardiovasc. Electrophysiol.
, 22
(8
), pp. 846
–850
.27.
Knecht
, S.
, Jaïs
, P.
, Nault
, I.
, Wright
, M.
, Matsuo
, S.
, Madaffari
, A.
, Lellouche
, N.
, O'Neill
, M. D.
, Derval
, N.
, and Deplagne
, A.
, 2008
, “Radiofrequency Puncture of the Fossa Ovalis for Resistant Transseptal Access
,” Circ.: Arrhythmia Electrophysiol.
, 1
(3
), pp. 169
–174
.28.
Smelley
, M. P.
, Shah
, D. P.
, Weisberg
, I.
, Kim
, S. S.
, Lin
, A. C.
, Beshai
, J. F.
, Burke
, M. C.
, and Knight
, B. P.
, 2010
, “Initial Experience Using a Radiofrequency Powered Transseptal Needle
,” J. Cardiovasc. Electrophysiol.
, 21
(4
), pp. 423
–427
.29.
Lehrmann
, H.
, Schneider
, J.
, Jadidi
, A. S.
, Park
, C. I.
, Schiebeling-Römer
, J.
, Allgeier
, J.
, Arentz
, T.
, and Weber
, R.
, 2014
, “Transseptal Access for Left Atrial Ablation: The Catheter-Probing Techniques are Not Without Risk
,” J. Cardiovasc. Electrophysiol.
, 25
(5
), pp. 479
–484
.30.
Esch
, J. J.
, Triedman
, J. K.
, Cecchin
, F.
, Alexander
, M. E.
, and Walsh
, E. P.
, 2013
, “Radiofrequency-Assisted Transseptal Perforation for Electrophysiology Procedures in Children and Adults With Repaired Congenital Heart Disease
,” Pacing Clin. Electrophysiol.
, 36
(5
), pp. 607
–611
.31.
Hu
, Y.-F.
, Tai
, C.-T.
, Lin
, Y.-J.
, Chang
, S.-L.
, Lo
, L.-W.
, Wongcharoen
, W.
, Udyavar
, A. R.
, Tuan
, T.-C.
, and Chen
, S.-A.
, 2008
, “The Change in the Fluoroscopy-Guided Transseptal Puncture Site and Difficult Punctures in Catheter Ablation of Recurrent Atrial Fibrillation
,” Europace
, 10
(3
), pp. 276
–279
.32.
Tomlinson
, D. R.
, Sabharwal
, N.
, Bashir
, Y.
, and Betts
, T. R.
, 2008
, “Interatrial Septum Thickness and Difficulty With Transseptal Puncture During Redo Catheter Ablation of Atrial Fibrillation
,” Pacing Clin. Electrophysiol.
, 31
(12
), pp. 1606
–1611
.33.
Faletra
, F. F.
, Nucifora
, G.
, and Ho
, S. Y.
, 2011
, “Imaging the Atrial Septum Using Real-Time Three-Dimensional Transesophageal Echocardiography: Technical Tips, Normal Anatomy, and Its Role in Transseptal Puncture
,” J. Am. Soc. Echocardiography
, 24
(6
), pp. 593
–599
.34.
Gafoor
, S.
, Schulz
, P.
, Heuer
, L.
, Matic
, P.
, Franke
, J.
, Bertog
, S.
, Reinartz
, M.
, Vaskelyte
, L.
, Hofmann
, I.
, and Sievert
, H.
, 2015
, “Use of EchoNavigator, a Novel Echocardiography-Fluoroscopy Overlay System, for Transseptal Puncture and Left Atrial Appendage Occlusion
,” J. Interventional Cardiol.
, 28
(2
), pp. 215
–217
.35.
Chierchia
, G. B.
, Capulzini
, L.
, de Asmundis
, C.
, Sarkozy
, A.
, Roos
, M.
, Paparella
, G.
, Boussy
, T.
, Van Camp
, G.
, Kerkhove
, D.
, and Brugada
, P.
, 2008
, “First Experience With Real-Time Three-Dimensional Transesophageal Echocardiography-Guided Transseptal in Patients Undergoing Atrial Fibrillation Ablation
,” Europace
, 10
(11
), pp. 1325
–1328
.36.
Faletra
, F. F.
, Pedrazzini
, G.
, Pasotti
, E.
, Muzzarelli
, S.
, Dequarti
, M. C.
, Murzilli
, R.
, Schlossbauer
, S. A.
, Slater
, I. P.
, and Moccetti
, T.
, 2014
, “3D TEE During Catheter-Based Interventions
,” JACC: Cardiovasc. Imaging
, 7
(3
), pp. 292
–308
.37.
Stec
, S.
, Zaborska
, B.
, Sikora-Frąc
, M.
, Kryński
, T.
, and Kułakowski
, P.
, 2011
, “First Experience With Microprobe Transesophageal Echocardiography in Non-Sedated Adults Undergoing Atrial Fibrillation Ablation: Feasibility Study and Comparison With Intracardiac Echocardiography
,” Europace
, 13
(1
), pp. 51
–56
.38.
Wu
, T.-G.
, Wang
, L.-X.
, Chen
, S.-W.
, Lin
, Z.-Q.
, Yan
, C.-J.
, and Huang
, L.-P.
, 2007
, “Value of Radiographic Esophageal Imaging in Determining an Optimal Atrial Septal Puncture Site for Percutaneous Balloon Mitral Valvuloplasty
,” Med. Princ. Pract.
, 17
(4
), pp. 280
–283
.39.
Ferguson
, J. D.
, Helms
, A.
, Mangrum
, J. M.
, Mahapatra
, S.
, Mason
, P.
, Bilchick
, K.
, McDaniel
, G.
, Wiggins
, D.
, and DiMarco
, J. P.
, 2009
, “Catheter Ablation of Atrial Fibrillation Without Fluoroscopy Using Intracardiac Echocardiography and Electroanatomic Mapping
,” Circ.: Arrhythmia Electrophysiol.
, 2
(6
), pp. 611
–619
.40.
Liang
, K.-W.
, Fu
, Y.-C.
, Lee
, W.-L.
, Wang
, K.-Y.
, Ting
, C.-T.
, Jan
, S.-L.
, Lin
, W.-W.
, and Lin
, I.-H.
, 2010
, “Comparisons of Mechanical Versus Phase-Array Intracardiac Echocardiography-Assisted Transseptal Puncture in Patients With Dilated Left Atrium Undergoing Percutaneous Transvenous Mitral Commissurotomy
,” J. Chin. Med. Assoc.
, 73
(9
), pp. 471
–476
.41.
Ruisi
, C. P.
, Brysiewicz
, N.
, Asnes
, J. D.
, Sugeng
, L.
, Marieb
, M.
, Clancy
, J.
, and Akar
, J. G.
, 2013
, “Use of Intracardiac Echocardiography During Atrial Fibrillation Ablation
,” Pacing Clin. Electrophysiol.
, 36
(6
), pp. 781
–788
.42.
Russo
, A. D.
, Russo
, E.
, Fassini
, G.
, Casella
, M.
, Innocenti
, E.
, Zucchetti
, M.
, Cefalú
, C.
, Solimene
, F.
, Mottola
, G.
, and Colombo
, D.
, 2013
, “Role of Intracardiac Echocardiography in Atrial Fibrillation Ablation
,” Journal of Atrial Fibrillation
, 5
(6
), pp. 118–135.43.
Biermann
, J.
, Bode
, C.
, and Asbach
, S.
, 2012
, “Intracardiac Echocardiography During Catheter-Based Ablation of Atrial Fibrillation
,” Cardiol. Res. Pract.
, 2012
, p. 921746.44.
Elagha
, A. A.
, Kocaturk
, O.
, Guttman
, M. A.
, Ozturk
, C.
, Kim
, A. H.
, Burton
, G. W.
, Kim
, J. H.
, Raman
, V. K.
, Raval
, A. N.
, and Wright
, V. J.
, 2008
, “Real-Time MR Imaging–Guided Laser Atrial Septal Puncture in Swine
,” J. Vasc. Interventional Radiol.
, 19
(9
), pp. 1347
–1353
.45.
Thiagalingam
, A.
, D'Avila
, A.
, Foley
, L.
, Fox
, M.
, Rothe
, C.
, Miller
, D.
, Malchano
, Z.
, Ruskin
, J. N.
, and Reddy
, V. Y.
, 2008
, “Full-Color Direct Visualization of the Atrial Septum to Guide Transseptal Puncture
,” J. Cardiovasc. Electrophysiol.
, 19
(12
), pp. 1310
–1315
.46.
Jeevan
, M.
, Jebaraj
, R.
, and Krishnakumar
, R.
, “In-Vitro Validation of Image Guided Surgery System With 3D Pre-Operative Visualization for Atrial Transseptal Puncture
,” IEEE
18th International Conference on Information Visualisation (IV)
, July 16–18, pp. 342
–345
.47.
Shepherd
, E. J.
, Gall
, S. A.
, and Furniss
, S. S.
, 2008
, “Interatrial Septal Puncture Without the Use of Fluoroscopy—Reducing Ionizing Radiation in Left Atrial Ablation Procedures
,” J. Interventional Card. Electrophysiol.
, 22
(3
), pp. 183
–187
.48.
Nguyen
, B.
, Merino
, J.
, Shachar
, Y.
, Estrada
, A.
, Doiny
, D.
, Castrejon
, S.
, Marx
, B.
, Johnson
, D.
, Marfori
, W.
, and Gang
, E. S.
, 2013
, “Non-Fluoroscopic Transseptal Catheterization During Electrophysiology Procedures Using a Remote Magnetic Navigation System
,” J. Atrial Fibrillation
, 6
(4
), pp. 6
–9
.49.
Pavlović
, N.
, Reichlin
, T.
, Kühne
, M.
, Knecht
, S.
, Osswald
, S.
, and Sticherling
, C.
, 2014
, “Fluoroscopy-Free Recrossing of the Interatrial Septum During Left Atrial Ablation Procedures
,” J Interventional Card. Electrophysiol.
, 41
(3
), pp. 261
–266
.50.
Unnithan
, A. G.
, Dexter
, B. C.
, Law
, I. H.
, and Von Bergen
, N. H.
, 2014
, “Limiting Left-Sided Catheter Dwelling Time Using 3D NavX to Mark and Reaccess the Left Atrium Via Prior Transseptal Puncture Site
,” J. Interventional Card. Electrophysiol.
, 40
(2
), pp. 125
–128
.51.
Mah
, D. Y.
, Miyake
, C. Y.
, Sherwin
, E. D.
, Walsh
, A.
, Anderson
, M. J.
, Western
, K.
, Abrams
, D. J.
, Alexander
, M. E.
, Cecchin
, F.
, and Walsh
, E. P.
, 2014
, “The Use of an Integrated Electroanatomic Mapping System and Intracardiac Echocardiography to Reduce Radiation Exposure in Children and Young Adults Undergoing Ablation of Supraventricular Tachycardia
,” Europace
, 16
(2
), pp. 277
–283
.52.
Saliba
, W.
, Reddy
, V. Y.
, Wazni
, O.
, Cummings
, J. E.
, Burkhardt
, J. D.
, Haissaguerre
, M.
, Kautzner
, J.
, Peichl
, P.
, Neuzil
, P.
, and Schibgilla
, V.
, 2008
, “Atrial Fibrillation Ablation Using a Robotic Catheter Remote Control System: Initial Human Experience and Long-Term Follow-Up Results
,” J. Am. Coll. Cardiol.
, 51
(25
), pp. 2407
–2411
.53.
Wagdi
, P.
, and Alkadhi
, H.
, 2012
, “Can Computer Tomography Help Predict Feasibility of Transseptal Puncture After Percutaneous Closure of an Interatrial Septal Communication?
,” J. Interventional Card. Electrophysiol.
, 34
(2
), pp. 167
–172
.54.
Verma
, S.
, Adler
, S.
, Berman
, A.
, Duran
, A.
, and Loar
, D.
, 2011
, “Localization of Fossa Ovalis and Brockenbrough Needle Prior to Left Atrial Ablation Using Three-Dimensional Mapping With EnSite Fusion™
,” J. Interventional Card. Electrophysiol.
, 30
(1
), pp. 37
–44
.55.
Schernthaner
, C.
, Danmayr
, F.
, Daburger
, A.
, Eichinger
, J.
, Hammerer
, M.
, and Strohmer
, B.
, 2013
, “High Incidence of Echocardiographic Abnormalities of the Interatrial Septum in Patients Undergoing Ablation for Atrial Fibrillation
,” Echocardiography
, 30
(4
), pp. 402
–406
.56.
Jayender
, J.
, Patel
, R. V.
, Michaud
, G. F.
, and Hata
, N.
, 2011
, “Optimal Transseptal Puncture Location for Robot-Assisted Left Atrial Catheter Ablation
,” Int. J. Med. Rob. Comput. Assisted Surg.
, 7
(2
), pp. 193
–201
.57.
Crystal
, M. A.
, Mirza
, M. A.
, and Benson
, L. N.
, 2010
, “A Radiofrequency Transseptal Needle: Initial Animal Studies
,” Catheterization Cardiovasc. Interventions
, 76
(5
), pp. 769
–773
.58.
Feld
, G. K.
, Tiongson
, J.
, and Oshodi
, G.
, 2011
, “Particle Formation and Risk of Embolization During Transseptal Catheterization: Comparison of Standard Transseptal Needles and a New Radiofrequency Transseptal Needle
,” J. Interventional Card. Electrophysiol.
, 30
(1
), pp. 31
–36
.59.
Winkle
, R. A.
, Mead
, R. H.
, Engel
, G.
, and Patrawala
, R. A.
, 2011
, “The Use of a Radiofrequency Needle Improves the Safety and Efficacy of Transseptal Puncture for Atrial Fibrillation Ablation
,” Heart Rhythm
, 8
(9
), pp. 1411
–1415
.60.
Karagöz
, T.
, Akın
, A.
, and Aykan
, H. H.
, 2014
, “NRGTM RF Powered Transseptal Needle: A Useful Technique for Transcatheter Atrial Septostomy and Fontan Fenestration: Report of Three Cases
,” Bosnian J. Basic Med. Sci.
, 14
(4
), pp. 259
–262
.61.
McWilliams
, M. J.
, and Tchou
, P.
, 2009
, “The Use of a Standard Radiofrequency Energy Delivery System to Facilitate Transseptal Puncture
,” J. Cardiovasc. Electrophysiol.
, 20
(2
), pp. 238
–240
.62.
Capulzini
, L.
, Paparella
, G.
, Sorgente
, A.
, de Asmundis
, C.
, Chierchia
, G. B.
, Sarkozy
, A.
, Muller-Burri
, A.
, Yazaki
, Y.
, Roos
, M.
, and Brugada
, P.
, 2010
, “Feasibility, Safety, and Outcome of a Challenging Transseptal Puncture Facilitated by Radiofrequency Energy Delivery: A Prospective Single-Centre Study
,” Europace
, 12
(5
), pp. 662
–667
.63.
Abed
, H. S.
, Alasady
, M.
, Lau
, D. H.
, Lim
, H. S.
, and Sanders
, P.
, 2012
, “Approach to the Difficult Transseptal: Diathermy Facilitated Left Atrial Access
,” Heart, Lung Circ.
, 21
(2
), pp. 108
–112
.64.
Greenstein
, E.
, Passman
, R.
, Lin
, A. C.
, and Knight
, B. P.
, 2012
, “Incidence of Tissue Coring During Transseptal Catheterization When Using Electrocautery and a Standard Transseptal Needle
,” Circ.: Arrhythmia Electrophysiol.
, 5
(2
), pp. 341
–344
.65.
Uchida
, B. T.
, Pavcnik
, D.
, Shimohira
, M.
, Choi
, Y. H.
, Jeromel
, M.
, Keller
, F. S.
, and Rösch
, J.
, 2011
, “New Coaxial Transseptal Needle for Creation of Atrial Septal Defects in Adult Sheep
,” Cardiovasc. Interventional Radiol.
, 34
(3
), pp. 620
–625
.66.
Wang
, Y.
, Xue
, Y. M.
, Mohanty
, P.
, Natale
, A.
, Li
, L.
, Wu
, W. F.
, Zhu
, C. M.
, Liu
, H.
, Zhong
, G. Q.
, and Zhu
, L. G.
, 2012
, “Dilator Method and Needle Method for Atrial Transseptal Puncture: A Retrospective Study From a Cohort of 4443 Patients
,” Europace
, 14
(10
), pp. 1450
–1456
.67.
Giudici
, M. C.
, Mickelsen
, S. R.
, Bhave
, P. D.
, Arteaga
, R. B.
, and Iqbal
, O. J.
, 2015
, “A Safe, Simple Technique for Transseptal Catheterization
,” Pacing Clin. Electrophysiol.
, 38
(3), pp. 295
–296
.68.
Katritsis
, G. D.
, Siontis
, G. C.
, Giazitzoglou
, E.
, Fragakis
, N.
, and Katritsis
, D. G.
, 2013
, “Complications of Transseptal Catheterization for Different Cardiac Procedures
,” Int. J. Cardiol.
, 168
(6
), pp. 5352
–5354
.69.
Koermendy
, D.
, Nietlispach
, F.
, Shakir
, S.
, Gloekler
, S.
, Wenaweser
, P.
, Windecker
, S.
, Khattab
, A. A.
, and Meier
, B.
, 2014
, “Amplatzer Left Atrial Appendage Occlusion Through a Patent Foramen Ovale
,” Catheterization Cardiovasc. Interventions
, 84
(7
), pp. 1190
–1196
.70.
Chierchia
, G.-B.
, Casado-Arroyo
, R.
, de Asmundis
, C.
, Rodriguez-Manero
, M.
, Sarkozy
, A.
, Conte
, G.
, Sieira
, J.
, Levinstein
, M.
, Baltogiannis
, G.
, and Di Giovanni
, G.
, 2013
, “Impact of Transseptal Puncture Site on Acute and Mid-Term Outcomes During Cryoballoon Ablation: A Comparison Between Anterior, Medial and Posterior Transatrial Access
,” Int. J. Cardiol.
, 168
(4
), pp. 4098
–4102
.71.
Haegeli
, L. M.
, Wolber
, T.
, Ercin
, E.
, Altwegg
, L.
, Krasniqi
, N.
, Novak
, P. G.
, Sterns
, L. D.
, Brunckhorst
, C. B.
, Lüscher
, T. F.
, and Leather
, R. A.
, 2010
, “Double Transseptal Puncture for Catheter Ablation of Atrial Fibrillation: Safety of the Technique and Its Use in the Outpatient Setting
,” Cardiol. Res. Pract.
, 2010
p. 295297
.72.
Medi
, C.
, Evered
, L.
, Silbert
, B.
, Teh
, A.
, Halloran
, K.
, Morton
, J.
, Kistler
, P.
, and Kalman
, J.
, 2013
, “Subtle Post-Procedural Cognitive Dysfunction After Atrial Fibrillation Ablation
,” J. Am. Coll. Cardiol.
, 62
(6
), pp. 531
–539
.73.
Feld
, G. K.
, and Yao
, B.
, 2014
, “Evaluation of the Safety and Effectiveness of the CryoMedix Cryoablation Catheter System for the Treatment of Atrial Flutter and Fibrillation
,” J. Interventional Card. Electrophysiol.
, 39
(1
), pp. 37
–44
.74.
De Ponti
, R.
, Marazzi
, R.
, Picciolo
, G.
, and Salerno-Uriarte
, J. A.
, 2010
, “Use of a Novel Sharp-Tip, J-Shaped Guidewire to Facilitate Transseptal Catheterization
,” Europace
, 12
(5
), pp. 668
–673
.75.
Krijthe
, B. P.
, Kunst
, A.
, Benjamin
, E. J.
, Lip
, G. Y.
, Franco
, O. H.
, Hofman
, A.
, Witteman
, J. C.
, Stricker
, B. H.
, and Heeringa
, J.
, 2013
, “Projections on the Number of Individuals With Atrial Fibrillation in the European Union, From 2000 to 2060
,” Eur. Heart J.
, 34
(35
), pp. 2746
–2751
.76.
Taramasso
, M.
, Maisano
, F.
, Latib
, A.
, Denti
, P.
, Guidotti
, A.
, Sticchi
, A.
, Panoulas
, V.
, Giustino
, G.
, Pozzoli
, A.
, and Buzzatti
, N.
, 2014
, “Conventional Surgery and Transcatheter Closure Via Surgical Transapical Approach for Paravalvular Leak Repair in High-Risk Patients: Results From a Single-Centre Experience
,” Eur. Heart J.–Cardiovasc. Imaging
, 15
(10
), pp. 1161
–1167
.77.
Baldus
, S.
, Schillinger
, W.
, Franzen
, O.
, Bekeredjian
, R.
, Sievert
, H.
, Schofer
, J.
, Kuck
, K. H.
, Konorza
, T.
, Möllmann
, H.
, and Hehrlein
, C.
, 2012
, “MitraClip Therapy in Daily Clinical Practice: Initial Results From the German Transcatheter Mitral Valve Interventions (TRAMI) Registry
,” Eur. J. Heart Failure
, 14
(9
), pp. 1050
–1055
.78.
Reddy
, V. Y.
, Holmes
, D.
, Doshi
, S. K.
, Neuzil
, P.
, and Kar
, S.
, 2011
, “Safety of Percutaneous Left Atrial Appendage Closure Results From the Watchman Left Atrial Appendage System for Embolic Protection in Patients With AF (PROTECT AF) Clinical Trial and the Continued Access Registry
,” Circulation
, 123
(4
), pp. 417
–424
.79.
Rana
, B. S.
, Shapiro
, L. M.
, McCarthy
, K. P.
, and Ho
, S. Y.
, 2010
, “Three-Dimensional Imaging of the Atrial Septum and Patent Foramen Ovale Anatomy: Defining the Morphological Phenotypes of Patent Foramen Ovale
,” Eur. J. Echocardiography
, 11
(10
), pp. i19
–i25
.80.
Gard
, J.
, Swale
, M.
, and Asirvatham
, S.
, 2011
, “Transseptal Access for the Electrophysiologist: Anatomic Considerations to Enhance Safety and Efficacy
,” J. Innovations Card. Rhythm Manage
, 2
, pp. 332
–338
.81.
Kautzner
, J.
, and Peichl
, P.
, 2012
, “The Role of Imaging to Support Catheter Ablation of Atrial Fibrillation
,” Cor Vasa
, 54
(6
), pp. e375
–e385
.82.
Sy
, R. W.
, Klein
, G. J.
, Leong-Sit
, P.
, Gula
, L. J.
, Yee
, R.
, Krahn
, A. D.
, and Skanes
, A. C.
, 2011
, “Troubleshooting Difficult Transseptal Catheterization
,” J. Cardiovasc. Electrophysiol.
, 22
(6
), pp. 723
–727
.83.
Tzeis
, S.
, Andrikopoulos
, G.
, Deisenhofer
, I.
, Ho
, S. Y.
, and Theodorakis
, G.
, 2010
, “Transseptal Catheterization: Considerations and Caveats
,” Pacing Clin. Electrophysiol.
, 33
(2
), pp. 231
–242
.Copyright © 2017 by ASME
You do not currently have access to this content.
