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.