Key result
MDCT-guided transseptal puncture matches ICE-guided puncture for procedural success and safety.
Why the study?
Intracardiac echo facilitates safe transseptal puncture during AF ablation but is limited in developing countries by cost, prompting evaluation of MDCT guidance as an alternative.
Does multidetector computed tomography (MDCT)-guided transseptal puncture prevent complications and maintain efficiency in patients undergoing atrial fibrillation catheter ablation compared to intracardiac echo (ICE)-guided transseptal puncture?
Cohort (n=802)
No
Does multidetector computed tomography (MDCT)-guided transseptal puncture prevent complications and maintain efficiency in patients undergoing atrial fibrillation catheter ablation compared to intracardiac echo (ICE)-guided transseptal puncture?
Absolute Event Rate: 0.27% vs 0.27%
p-value: p=0.997
MDCT-guided transseptal puncture demonstrates equivalent efficiency and safety to ICE-guided puncture for atrial fibrillation ablation, offering a reliable and less costly alternative when ICE is unavailable.
MDCT may offer a feasible ICE alternative for transseptal puncture; leaves open need for randomized confirmation before broader adoption.
Background 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. Methods 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. Results 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 ( R 2 = 0.14, p = .006). Conclusion 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.
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Lü et al. (2023) conducted a cohort in Atrial Fibrillation (n=802). Multidetector computed tomography (MDCT)-guided transseptal puncture vs. Intracardiac echo (ICE)-guided transseptal puncture was evaluated on TSP-related complication (cardiac tamponade, aortic root puncture, and peri-operative death) (p=0.997). MDCT-guided transseptal puncture demonstrated an identical 100% success rate and equivalent safety (0.27% cardiac tamponade rate, p=0.997) compared to ICE-guided transseptal puncture.
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