Transeptal Approach to Ablation of Left‐Sided Arrhythmias Does Not Lead to Persisting Interatrial Shunt: A Transesophageal Echocardiographic Study

In experienced hands, antegrade left heart catheterization via a transeptal puncture is a safe and effective method of performing radiofrequency ablation on the left side of the heart. Persistence of atrial septal defect following transeptal puncture for mitral valvuloplasty has been widely reported although hemodynamically significant shunts are rare. To investigate the persistence of interatrial shunt following transeptal puncture in patients undergoing left-sided electrophysiological procedures using TEE. Fifty-one adult patients, 20 men, aged 19-82 (mean 42.4) years underwent 55 transeptal punctures. Either an 8 Fr Mullins or 8 Fr Swartz transeptal sheath was deployed in all cases. Of these, 28 consecutive patients were approached and 26 consented to undergo TEE. TEE was performed at least 3 weeks post transeptal puncture using a single-plane transducer for the first 18 patients, superseded by a multiplane transducer for the later cases. Both color flow Doppler and microcavitation contrast imaging of the interatrial septum were performed. One patient in the single-plane transducer group was excluded as the failed to swallow the TEE probe. In the remaining 25 patients studied, 9 men aged 21-82 (mean 44.1) years, TEE was performed at a mean of 12.2 (range 3-52) weeks post procedure. No evidence of interatrial shunt was detected by either color flow or contrast studies. Transeptal puncture used in electrophysiological procedures does not result in interatrial shunts persisting > 3 weeks post procedure.