Impact of single versus double transseptal puncture on outcome and complications in pulmonary vein isolation procedures

Figures

• 

  Figure 1. A. Left anterior oblique (LAO) 50° view. Single transseptal puncture; a — Agilis sheath (St. Jude, Abbott, St. Paul, MN, USA) in the left atrium with a 10 polar spiral-catheter in the left superior pulmonary vein; b — diagnostic catheter in the right ventricular apex; c — diagnostic catheter in the coronary sinus; d — temperature probe in esophagus; B. LAO 50° view. Double transseptal puncture; a — SL0 Sheath (St. Jude, Abbott, St. Paul, MN, USA) in the left atrium with a 10 polar spiral-catheter in the left superior pulmonary vein; b — Agilis sheath (St. Jude, Abbott, St. Paul, MN, USA) with ablation catheter ostial of the left superior pulmonary vein; c — diagnostic catheter in the right ventricular apex; d — diagnostic catheter in coronary sinus; e — temperature probe in the esophagus.

• 

  Figure 2. Electrocardiogramm during ablation. I, II, V1, V6 = Surface-electrocardiogram, MAP = ablation catheter, Lasso 1–10 = 10 polar spiral-catheter in the left superior pulmonary vein: a — farfield atrial signal; b — pulmonary vein signal; c — farfield ventricular signal; d — no pulmonary vein signal anymore; CS 1–10 — catheter in the coronary sinus; RVA — catheter in the right ventricular apex. The 10 polar spiral-catheter is placed in the left superior pulmonary vein. During ablation around the left superior pulmonary vein, the pulmonary vein signal on the spiral-catheter disappears (b → d). This means that the vein was isolated, because there was hence, no signal passing the ablation line.

• 

  Figure 3. A. Radiation dose in single and double transseptal puncture (TSP); B. Radiation time in single and double TSP; C. Recurrence in single and double TSP.