What is the clinical evidence from this study?

Study design: Observational. Population: Arrhythmias requiring left heart catheterization for radiofrequency catheter ablation (n=19). Intervention: Intracardiac echocardiography (ICE)-guided transseptal puncture. Primary outcome: Shift of the puncture site in the fossa ovalis.

January 1, 2003Open Access

Shifting of Puncture Site in the Fossa Ovalis During Radiofrequency Catheter Ablation: Intracardiac Echocardiography-guided Transseptal Left Heart Catheterization

Resultado clave

Intracardiac echocardiography-guided transseptal puncture revealed that the puncture site shifted towards the upper edge of the fossa ovalis in 89% of patients.

Diseño del estudio

Tipo

Observational (n=19)

PICO estructurado

Does intracardiac echocardiography (ICE) improve the safety and anatomical landmark identification during transseptal puncture in patients undergoing radiofrequency catheter ablation?

Población

19 patients (mean age 48.6 years, 47.4% female) without structural heart disease requiring left heart catheterization for radiofrequency catheter ablation.

Intervención

Intracardiac echocardiography (ICE) guided transseptal puncture

Resultado

Anatomical landmark identification (fossa ovalis dimensions, puncture site shift) and safety distance verificationsurrogate

Intracardiac echocardiography is a useful adjunct for safely guiding transseptal puncture during radiofrequency catheter ablation by visualizing the fossa ovalis and ensuring adequate distance to the atrial wall.

Limitaciones

Vertical diameter of the fossa ovalis was measured by fluoroscopy, which might not be as accurate as ICE.
The study was performed in patients with structurally normal hearts, so applicability to patients with structural abnormalities is unclear.
Small sample size without a randomized control group.

Resumen

Intracardiac echocardiography (ICE) serves as an adjunct to fluoroscopy for electrophysiological procedures by identifying critical anatomic landmarks and confirming catheter-endocardial contact. In the present study, we investigated the usefulness of ICE for radiofrequency catheter ablation. ICE was utilized to guide transseptal puncture in 19 patients undergoing radiofrequency catheter ablation. The fossa ovalis, which was one critical anatomic landmark, had an average vertical diameter of 18.5 +/- 6.9 mm and an average horizontal diameter of 10.0 +/- 2.4 mm, as measured by ICE and fluoroscopy. Although there was only a small shift of the puncture site in the horizontal direction, the puncture site shifted towards the upper edge of the fossa ovalis for 17 patients (89%). Furthermore, we could verify that the distance between the apex of the tent-shape formed by the pressure of the puncture needle in the fossa ovalis and the left atrial wall opposing it was sufficient to carry out the procedure safely. Confirming the puncture site using ICE is useful in carrying out transseptal left heart catheterization safely.

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