Transseptal puncture in patients with intracardiac devices
Available data in the literature on fluoroless TSP in the presence of
CIEDs is scarce. Fluoroless approach for transseptal access is usually
avoided or fluoroscopy is used at least to some extent during the
procedure (9). In our study, 51 TSPs in 36 CIED patients were entirely
ICE-guided with good visualization of the leads. However, we recorded
one dislocation of the ventricular lead during TSP in VT ablation
procedure. Lead dislocation due to entanglement with catheter system was
intraoperatively detected with ICE. Thus, in patients with CIED caution
is advised when attempting entirely ICE-guided TSP. Brief use of
fluoroscopy for CIED lead visualization during long sheath / dilator/
transseptal needle assembly and during different stages of the CA
procedure is probably reasonable if entanglement is suspected.