Intracardiac echocardiography-guided transseptal puncture
To facilitate TSP, ICE or TEE are used as additional imaging tools when
difficult anatomy is encountered during fluoroscopy-guided TSP (5,6).
Although cost-effectiveness in routine practice compared to TEE is
unclear, ICE has additional advantages of not requiring a second
operator, general anesthesia and provides better acoustic window.
Furthermore, integration of ICE with 3D EAM systems enabled CA
procedures of various arrhythmias without the use of fluoroscopy (7,11).
There are several reasons to adopt radiation-reducing strategies in CA
procedures. The ALARA (as low as reasonably achievable) principle is
based on the hypothesis that there is no threshold below which ionizing
radiation is free from harmful effects for the operator and the patient
(12). Furthermore, patient radiation risk from CA procedures may highly
exceed radiation risk from common radiological procedures (13).
There is limited data regarding feasibility and safety of ICE-guided TSP
in CA of left-sided arrhythmias without the use of fluoroscopy.
Recently, Baykaner al. (9) demonstrated efficacy and safety of zero
fluoroscopy TSPs in 646 AF patients using multiple procedural approaches
at 5 high-volume centers. Our results extend these finding with a more
simplified fluoroless transseptal approach which was also used in a
pediatric population, in patients with CIEDs, and in various left-sided
arrhythmias not only AF.