title: Transseptal Puncture Guided by CT-Derived 3D-Augmented Fluoroscopy.
abstract: BACKGROUND
  Transseptal puncture for left atrial (LA) access is still mainly performed using fluoroscopy and transesophageal or intracardiac echocardiography. We present an easily applicable approach for the guidance of transseptal puncture that uses the combination of a 3D-mapping system and CT-derived 3D-overlayed anatomy.
  
  
  RESULTS
  A computer tomographic (CT) LA-angiography was performed in n = 65 patients prior to a scheduled atrial fibrillation ablation procedure. The CARTO3 (Biosense Webster, Diamond Bar, CA, USA) segmentation tool was used to create a 3D-reconstruction of cardiac anatomy and the spine. The CARTO UNIVU module was then used to overlay and register the segmented 3D-anatomy onto fluoroscopy. The 3D-reconstructed spine and cardiac anatomy were congruently aligned to their fluoroscopic counterparts in fluoroscopic views. The feasibility of the technique, its safety, and accuracy (assessed as contour offsets between 3D-overlay and angiographic LA anatomy) were evaluated. Overlay registration accuracy was analyzed by CARTO3 registration matrices. Transseptal puncture was feasible without complications in all 65 patients using the new 3D-overlay technique. Three-dimensional-overlay contour offsets were 1.6 ± 1.2 mm in left PV, 1.7 ± 1.2 mm in right PV, and 1.3 ± 1.0 mm in the LA roof region. Overlay registration accuracy was 4.9 ± 2.7 mm. The average time needed for anatomy segmentation was 204 ± 61 seconds, time needed for overlay registration was 18 ± 8 seconds.
  
  
  CONCLUSIONS
  Three-dimensional-augmented fluoroscopy is feasible, safe, and easy to apply as guidance for transseptal puncture and demonstrates a high level of accuracy.
authors.affiliation: Department of Electrophysiology, German Heart Center Munich, Technische, Universitaet Munich, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Bourier
authors.affiliation: Department of Electrophysiology, German Heart Center Munich, Technische, Universitaet Munich, Germany.
authors.forename: Tilko
authors.initials: T
authors.lastname: Reents
authors.affiliation: Department of Electrophysiology, German Heart Center Munich, Technische, Universitaet Munich, Germany.
authors.forename: Sonia
authors.initials: S
authors.lastname: Ammar-Busch
authors.affiliation: Department of Electrophysiology, German Heart Center Munich, Technische, Universitaet Munich, Germany.
authors.forename: Verena
authors.initials: V
authors.lastname: Semmler
authors.affiliation: Department of Electrophysiology, German Heart Center Munich, Technische, Universitaet Munich, Germany.
authors.forename: Marta
authors.initials: M
authors.lastname: Telishevska
authors.affiliation: Department of Electrophysiology, German Heart Center Munich, Technische, Universitaet Munich, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Kottmaier
authors.affiliation: Department of Electrophysiology, German Heart Center Munich, Technische, Universitaet Munich, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Lennerz
authors.affiliation: Department of Electrophysiology, German Heart Center Munich, Technische, Universitaet Munich, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Grebmer
authors.affiliation: Department of Electrophysiology, German Heart Center Munich, Technische, Universitaet Munich, Germany.
authors.forename: Christof
authors.initials: C
authors.lastname: Kolb
authors.affiliation: Department of Electrophysiology, German Heart Center Munich, Technische, Universitaet Munich, Germany.
authors.forename: Isabel
authors.initials: I
authors.lastname: Deisenhofer
authors.affiliation: Department of Electrophysiology, German Heart Center Munich, Technische, Universitaet Munich, Germany.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Hessling
mesh_terms: D000072226:Computed Tomography Angiography / Q000379:methods*; D005471:Fluoroscopy / Q000379:methods*; D006346:Heart Septum / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D011677:Punctures / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods*
keywords: 3D-mapping systems; 3D-overlay; atrial fibrillation ablation; fluoroscopy; transseptal puncture