Key result
Multimodality imaging guides successful single-puncture transseptal cryoballoon ablation in cor triatriatum sinister.
Why the study?
This report describes a sequential multimodality imaging strategy for transseptal access during cryoballoon ablation in a patient with cor triatriatum sinister (CTS).
Case Report (n=1)
No
A sequential multimodality imaging strategy combining cardiac CT, real-time TEE, contrast, and fluoroscopy enables safe and effective tailored transseptal access for cryoballoon ablation in patients with cor triatriatum sinister.
May support imaging-guided cryoballoon PVI in rare CTS cases; hypothesis-generating and should not yet change practice.
To describe a sequential multimodality imaging strategy for transseptal access during cryoballoon ablation in a patient with cor triatriatum sinister (CTS). Methods: A 55-year-old man with paroxysmal atrial fibrillation and CTS underwent preprocedural cardiac computed tomography (CCT), followed by real-time transesophageal echocardiography (TEE), contrast confirmation, and fluoroscopic guidance during the procedure. Results: CCT demonstrated pulmonary vein drainage into a Proximal Chamber (Posterior-Superior), separated from the Distal Chamber (Anterior-Inferior) by a membrane. Real-time TEE identified and confirmed an anterosuperior transseptal site, with septal tenting before needle passage. After a single BRK needle puncture, contrast confirmed access to the pulmonary-vein-containing chamber, allowing advancement of the FlexCath Advance catheter (Medtronic) and cryoballoon isolation of all 4 pulmonary veins without procedural complications. Conclusion: In CTS, transseptal access should be tailored to the individual atrial anatomy. Sequential use of CCT, real-time TEE, contrast, and fluoroscopy can provide complementary information at the successive stages of the procedure.
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Romano et al. (2026) conducted a case report in Paroxysmal atrial fibrillation and cor triatriatum sinister (n=1). Sequential multimodality imaging-guided transseptal strategy (cardiac CT, real-time TEE, contrast confirmation, and fluoroscopy) for cryoballoon ablation was evaluated on Transseptal access and cryoballoon isolation of all 4 pulmonary veins without procedural complications. Sequential multimodality imaging guidance enabled transseptal access with a single puncture and cryoballoon isolation of all 4 pulmonary veins without complications in 1 patient with CTS.
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