Intracardiac echocardiography to guide transseptal left heart catheterization for radiofrequency catheter ablation.
BACKGROUND
The purpose of this study was to assess the feasibility and safety of intracardiac echocardiography to guide transseptal puncture for radiofrequency catheter ablation.


RESULTS
Transcatheter intracardiac echocardiography (9 MHz) was utilized to guide transseptal puncture in 53 patients undergoing radiofrequency catheter ablation. The anatomy and relationship of intra- and extracardiac structures were visualized with the ultrasound transducer positioned at the fossa ovalis. The tip of the transseptal dilator and tenting of the fossa ovalis and the left atrial wall were simultaneously visualized in a single ultrasound image in all patients. With maximum tenting of the fossa ovalis, the mean distance from the fossa to the left atrial wall was 11.9 +/- 5.8 mm (range: 1.8 to 25.6 mm). In four patients (8%), the tented fossa ovalis abutted the left atrial wall and the transseptal dilator was redirected with ultrasound guidance. Puncture of the interatrial septum was achieved through the fossa ovalis in each patient and required a single attempt in 51 patients (96%). The mean number of punctures per patient was 1.1 +/- 0.4. The mean time to perform transseptal catheterization was 18.2 +/- 6.8 minutes. There were no complications.


CONCLUSIONS
Intracardiac echocardiography delineated the anatomy of intra- and extracardiac structures not identified with fluoroscopy and simplified correct positioning of the transseptal dilator, puncture of the fossa ovalis, and cannulation of the left atrium in a timely and uncomplicated fashion.
Daoud
E G
EG
Mid-Ohio Cardiology Research, Riverside-Methodist Hospital, Columbus, Ohio, USA.
Kalbfleisch
S J
SJ
Hummel
J D
JD
D000293:Adolescent; D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D006328:Cardiac Catheterization; D017115:Catheter Ablation / Q000379:methods*; D004452:Echocardiography / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging; D006346:Heart Septum / Q000000981:diagnostic imaging* / Q000601:surgery; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D011677:Punctures; D013318:Stroke Volume