title: Added value of transoesophageal echocardiography during transseptal puncture performed by inexperienced operators.
abstract: OBJECTIVE
  Transseptal puncture (TP) appears to be safe in experienced hands; however, it can be associated with life-threatening complications. The aim of our study was to demonstrate the added value of routine use of transoesophageal echocardiography (TEE) for the correct positioning of the transseptal system in the fossa ovalis, thus potentially preventing complications during fluoroscopy-guided TP performed by inexperienced operators.
  
  
  RESULTS
  Two hundred and five patients undergoing pulmonary vein isolation procedure (PVI) for drug-resistant paroxysmal or persistent atrial fibrillation were prospectively included. When the operator (initially blinded to TEE) assumed that the transseptal system was in a correct position according to fluoroscopical landmarks, the latter was then checked with TEE unblinding the physician. If necessary, further refinement of the catheter position was performed. Refinement >10 mm, or in case of catheter pointing directly at the aortic root or posterior wall were considered as major repositioning. Thirty-four patients required major repositioning. Regression analysis revealed age (P: 0.0001, Wald: 12.9, 95% confidence interval: 1.04-1.16), left atrial diameter (P: 0.01, Wald: 6.6, 95% confidence interval: 1.04-1.34), previous PVI (P: 0.01, Wald: 6.3, 95% confidence interval: 1.31-8.76), and atrial septal thickness (P: 0.03, Wald: 4.5, 95% confidence interval: 1.05-3.4) as independent predictors of major revision with TEE.
  
  
  CONCLUSIONS
  Routine 2D TEE in addition to traditional fluoroscopic TP appears to be very useful to guide the TP assembly in a correct puncture position and thus, to avoid TP-related complications. However, further randomized prospective comparative studies are necessary to support these suggestions.
authors: Heart Rhythm Management Center, UZ Brussels-VUB, Laarbeeklaan 101, Brussel 1090, Belgium. dfatihbayrak@yahoo.com
authors: Fatih
authors: F
authors: Bayrak
authors: Gian-Battista
authors: GB
authors: Chierchia
authors: Mehdi
authors: M
authors: Namdar
authors: Yoshinao
authors: Y
authors: Yazaki
authors: Andrea
authors: A
authors: Sarkozy
authors: Carlo
authors: C
authors: de Asmundis
authors: Stephan Andreas
authors: SA
authors: Muller-Burri
authors: Jayakeerthi
authors: J
authors: Rao
authors: Danilo
authors: D
authors: Ricciardi
authors: Antonio
authors: A
authors: Sorgente
authors: Pedro
authors: P
authors: Brugada
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000601:surgery*; D002309:Cardiology / Q000193:education* / Q000592:standards; D017115:Catheter Ablation / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D017548:Echocardiography, Transesophageal / Q000379:methods* / Q000592:standards; D004502:Education, Medical, Continuing / Q000379:methods*; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005471:Fluoroscopy; D006346:Heart Septum / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000601:surgery; D011677:Punctures / Q000379:methods* / Q000592:standards; D012372:ROC Curve