Mediguide-Assisted Transseptal Puncture without Echocardiographic Guidance

Autor:	R N Elene Janiashvili, Pablo Ramos Ardanaz, R N Cristina Díaz Fernández, R N Graciela López González, Ignacio García-Bolao, Renzo Neglia, Gabriel Ballesteros, Marcel Palacio Solís
Rok vydání:	2017
Předmět:	medicine.medical_specialty Intracardiac echocardiography Percutaneous medicine.diagnostic_test business.industry medicine.medical_treatment Atrial fibrillation Catheter ablation General Medicine 030204 cardiovascular system & hematology medicine.disease Ablation 03 medical and health sciences 0302 clinical medicine Internal medicine Cardiology Medicine Fluoroscopy 030212 general & internal medicine Cardiology and Cardiovascular Medicine business Nuclear medicine Left Pulmonary Vein Conventional technique
Zdroj:	Pacing and Clinical Electrophysiology. 40:545-550
ISSN:	0147-8389
DOI:	10.1111/pace.13039
Popis:	Background First description of a technique for left atrium transseptal puncture (TSP) with minimal radiation exposure by using the nonfluoroscopic MediGuide™ tracking system (MG; St. Jude Medical, St. Paul, MN, USA) without the assistance of intracardiac echocardiography. Methods This study included 31 consecutive patients with atrial fibrillation undergoing an MG-assisted percutaneous catheter ablation procedure. A Brockenbrough transseptal needle (BRK) is connected to a standard pressure transducer through a two-input valve. Then, an MG-enabled guidewire is inserted so that its tip exactly matches the BRK's distal tip. After the acquisition of two short radioscopic cine-loops we are able to trace the needle tip on the MG screen, performing the usual TSP maneuver but without fluoroscopy. Successful left atrium access is confirmed by noticing the change in the pressure curve and by advancing the guidewire into the left pulmonary veins. As a control group, 31 matched patients who underwent atrial fibrillation ablation with fluoroscopically guided, pressure-monitored TSP were included. Results Sixty-two MG-assisted TSP attempts were performed; all but two were successfully accomplished without changing to the conventional technique (96.7%). The mean total fluoroscopy time, until the double transseptal access was performed, was 26.65 ± 37.97 seconds in the MG group and 129.13 ± 37.77 seconds in the conventional-TSP group (P < 0.001). No major complications occurred during any of the procedures. Conclusion This new technique for TSP using MG is feasible and can be performed with minimal radiation exposure without the need for additional imaging techniques, achieving a significant reduction of fluoroscopy time.
Databáze:	OpenAIRE
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