title: Feasibility of Transseptal Puncture Using a Nonfluoroscopic Catheter Tracking System.
abstract: BACKGROUND
  Radiation exposure in the electrophysiology lab is a major occupational hazard to the electrophysiologists. A catheter localization system (MediGuide Technology, St. Jude Medical Inc., St. Paul, MN, USA) allows the integration of electroanatomical mapping and x-ray imaging, and has been shown to be effective in reducing radiation exposure during several electrophysiological procedures. We intended to evaluate the feasibility of this catheter tracking system to guide transseptal (TS) access.
  
  
  METHODS
  The feasibility of performing TS puncture with MediGuide (MDG) was assessed in a prospective observational study in 16 patients undergoing radiofrequency ablation for atrial fibrillation. These patients were compared to 16 matched patients undergoing similar procedures during the same time frame using conventional approach. There were no differences in mean age, gender distribution, and body mass index between the two groups. Total duration of fluoroscopic exposure during TS puncture was compared between the two groups.
  
  
  RESULTS
  All patients underwent successful TS puncture. Fluoroscopy time for double TS puncture using the MDG system was significantly lower than the control group (0.48 ± 0.17 minutes vs. 5.9 ± 0.65 minutes; P < 0.0001). No major complications occurred during the procedures in either group.
  
  
  CONCLUSIONS
  TS puncture can be successfully performed using MDG, and results in significant reduction in radiation exposure.
authors.affiliation: Cardiac Arrhythmia Service, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Moussa
authors.initials: M
authors.lastname: Mansour
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas.
authors.forename: Muhammad R
authors.initials: MR
authors.lastname: Afzal
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas.
authors.forename: Sampath
authors.initials: S
authors.lastname: Gunda
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas.
authors.forename: Jayasree
authors.initials: J
authors.lastname: Pillarisetti
authors.affiliation: Cardiac Arrhythmia Service, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Kevin
authors.initials: K
authors.lastname: Heist
authors.affiliation: Cardiac Arrhythmia Service, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Moshe Rav
authors.initials: MR
authors.lastname: Acha
authors.affiliation: St. Jude Medical, Inc, Kansas City, Kansas.
authors.forename: Michael
authors.initials: M
authors.lastname: Heard
authors.affiliation: Cardiac Arrhythmia Service, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Ruskin
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas.
authors.forename: Dhanunjaya
authors.initials: D
authors.lastname: Lakkireddy
mesh_terms: D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000601:surgery*; D062906:Cardiac Catheters; D017115:Catheter Ablation / Q000295:instrumentation / Q000379:methods; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005240:Feasibility Studies; D005471:Fluoroscopy; D006346:Heart Septum / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D011677:Punctures / Q000295:instrumentation* / Q000379:methods; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000032:analysis*; D011835:Radiation Protection / Q000379:methods; D015641:Radiography, Interventional / Q000295:instrumentation*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
keywords: MediGuide radiation reduction; TS puncture; catheter visualization; three-dimensional mapping system