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.