Introduction
The transseptal puncture (TSP) is a routine procedure in electrophysiology to perform catheter ablation (CA) of atrial fibrillation (AF) and other left-sided arrhythmias including ventricular tachycardias (VT) (1).
Although fluoroscopic guidance to perform TSP is still the gold standard in clinical practice (2,3), ultrasound-based techniques including transesophageal echocardiography (TEE) and intracardiac echocardiography (ICE) have been adopted to provide additional imaging of different anatomical structures relevant to TSP. Utilization of both imaging techniques could shorten fluoroscopy exposure, increase safety and success rate of electrophysiological procedures, especially in challenging cases (4-6). Furthermore, improvement of image quality and integration with three-dimensional 3D electro-anatomic mapping (EAM) systems enabled ICE to become an invaluable tool for safe and effective guidance of catheters and needle direction during TSP without the use of fluoroscopy (7). While the fundamental technique of performing ICE-based TSP in flouroless approach remains the same, available data to support routine use of this technique is relatively scarce. In addition, there are some considerations regarding safety and efficacy, especially in the pediatric population and in patients with cardiac implantable electronic devices (CIEDs) (8,9).
The purpose of this single-center retrospective study was to evaluate efficacy and safety of consecutive entirely ICE-guided TSPs in patients undergoing fluoroless CA for different left-sided tachycardias. Pediatric population and patients with CIEDs were also included in the analysis.