title: Safety and efficacy of transseptal puncture guided by real-time fusion of echocardiography and fluoroscopy.
abstract: OBJECTIVE
  Visual guidance through echocardiography and fluoroscopy is crucial for a successful transseptal puncture (TSP) in a prespecified region of the fossa ovalis. The novel EchoNavigator system Release II (EchoNav II, Philips Healthcare, Andover, Massachusetts, USA) enables the real-time fusion of fluoroscopic and echocardiographic images. We evaluated this new imaging method in respect to safety and efficacy of TSP during MitraClip implantation and left atrial appendage closure.
  
  
  METHODS
  Forty-four patients before (-EchoNav) and 44 patients after (+EchoNav) the introduction of real-time fusion were included in our retrospective, single-centre study. The primary endpoint was the occurrence of adverse events due to TSP. Secondary endpoints were successful puncture at the prespecified region and time until TSP (min).
  
  
  RESULTS
  In both groups TSP was performed successfully in the prespecified region and no adverse events occurred during or due to the accomplishment of TSP. Time until TSP was significantly reduced in the +EchoNav group in comparison with the EchoNav group (18.48 ± 5.62 min vs. 23.20 ± 9.61 min, p = 0.006).
  
  
  CONCLUSIONS
  Real-time fusion of echocardiography and fluoroscopy proved to be as safe and successful as standard best practice for TSP. Moreover, efficacy was improved through significant reduction of time until TSP.
authors.affiliation: Division of Cardiology, Pneumology, and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf, Düsseldorf, Germany. Shazia.Afzal@med.uni-duesseldorf.de.
authors.forename: S
authors.initials: S
authors.lastname: Afzal
authors.affiliation: Division of Cardiology, Pneumology, and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf, Düsseldorf, Germany.
authors.forename: V
authors.initials: V
authors.lastname: Veulemans
authors.affiliation: Division of Cardiology, Pneumology, and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf, Düsseldorf, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Balzer
authors.affiliation: Department of Cardiology, University Hospital Essen, Westgerman Heart-and Vascular Centre, Essen, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Rassaf
authors.affiliation: Division of Cardiology, Pneumology, and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf, Düsseldorf, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Hellhammer
authors.affiliation: Division of Cardiology, Pneumology, and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf, Düsseldorf, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Polzin
authors.affiliation: Division of Cardiology, Pneumology, and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf, Düsseldorf, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Kelm
authors.affiliation: Division of Cardiology, Pneumology, and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf, Düsseldorf, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Zeus
keywords: EchoNavigator system Release II; Left atrial appendage closure; MitraClip implantation; Transseptal puncture