Clinical implications
Transseptal access is the key step in radiation-reducing strategies for
CA of left-sided arrhythmias. Our data suggests that an entirely
ICE-guided TSP enables operators to achieve completely fluoroless
ablation procedures without compromising safety and efficacy.
Fluoroscopy-based studies report, albeit rarely, complications such as
right atrial wall puncture, aortic root puncture and embolisms which
were not detected in the present study (1,2,18). Routine use of ICE does
not only provide real time visualization of IAS anatomy relevant to TSP
but also facilitates early recognition of potential procedural
complications such as formation of thrombus, signs of impending steam
pop or pericardial effusion. In our study we had two aborted cases due
to early recognition of thrombus with ICE which in theory prevented an
adverse event.