Interv Akut Kardiol. 2002;1(2):81-84

Simple and double transseptal catheterization in clinical electrophysiology - practical approach in the electophysiologic lab without previous experience with the method

Martin Fiala, Petr Heinc, Jan Lukl

I. interní klinika FN a LF UP Olomouc

Summary: Transseptal catheterization, including double transseptal catheterization, represents an essential and more frequently used method in clinical electrophysiology in the era of catheter ablation of atrial fibrillation.

Method: Transseptal catheterization was successfully performed in 36 from 37 patients (9 women) on whom the procedure was started. Mean age of patients was 52,7 ± 3,1 (21–74) years. The transseptal set designed for clinical electrophysiology includes the Brockenbrough needle and a long sheath with a dilatator was used for the procedure. The method utilizes two projective views of an electrophysiologist on heart anatomy and the use of devices to aid in anatomic orientation of the catheter to the coronary sinus, and in the visualization of the left-sided heart chambers and vessels in the venous phase of angiography of the pulmonary artery.

Results: In one patient the procedure was prematurely stopped with no complications, because the attempt to penetrate into the left atrium by the thin tip of the Brockenbrough needle was unsuccessful. In two patients with ectopic tachycardia and in three patients with monomorphic macro-reentry tachycardia, simple transseptal catheterization was performed, while in 31 patients, designated for ablation because of atrial fibrillation, double transseptal catheterization by two independent punctures was carried out. Altogether, 67 transseptal catheterizations were completed, none of them being directly associated with any complications.

One procedure was complicated by the late development of an arterial pseudoaneurysm in the groin in place of the previously introduced transseptal sheaths. This was solved by compression without any further consequences.

Conclusion: Use of two dimensional skiascopic view and devices allowing orientation in heart anatomy facilitate, from the beginning, the implementation of transseptal catheterization, double included, with high efficacy and safety.

Keywords: transseptal catheterization, clinical electrophysioloy, oblique skiascopic projections, angiography of pulmonary artery.

Published: December 31, 2002  Show citation