ABSTRACT
Since the development of radiofrequency catheter ablation for the treatment of atrial fibrillation, electrophysiology laboratories have experienced a significant rise in the number of transseptal catheterization procedures. Traditionally, the procedure requires the presence of a interventional cardiologist who carries out transseptal catheterization following arterial puncture and placement of a reference pigtail catheter in the aortic root. Use of His bundle and coronary sinus catheters to provide anatomical and electrophysiological landmarks enables transseptal catheterization to be carried out without the need for arterial puncture or intracavity pressure measurement. We report our experience with transseptal catheterization in an electrophysiology laboratory using only electrophysiological landmarks. The procedure was carried out on 68 occasions and was successful in all patients except one, in whom catheterization could not be performed for anatomical reasons and because the patient had previously received anticoagulation therapy. One other patient developed transient ST elevation, which was probably due to an air embolism.
Subject(s)
Bundle of His/physiology , Cardiac Catheterization/methods , Catheter Ablation/methods , Sinoatrial Node/physiology , Cardiac Catheterization/instrumentation , HumansABSTRACT
Desde el desarrollo de la ablación con radiofrecuencia para el tratamiento curativo de la fibrilación auricular, los laboratorios de electrofisiología han experimentado un incremento considerable en el número de cateterismos transeptales. Tradicionalmente, el procedimiento requería la intervención de un hemodinamista que procedía a realizar el cateterismo transeptal previa punción arterial y colocación de un catéter pigtail de referencia en la raíz aórtica. Utilizando el catéter del His y el del seno coronario como referencias anatomo-electrofisiológicas se puede llevar a cabo el cateterismo transeptal sin necesidad de realizar punción arterial ni medición de presiones intracavitarias. Presentamos nuestra experiencia en cateterización transeptal en el laboratorio de electrofisiología utilizando referencias puramente electrofisiológicas. Hemos realizado el procedimiento en 68 ocasiones, con resultado exitoso en todos los casos salvo en uno, en el que la punción no pudo llevarse a cabo por dificultades en el acceso anatómico y porque el paciente se encontraba previamente anticoagulado. Un paciente presentó elevación transitoria del segmento ST, probablemente debida a un embolismo aéreo
Since the development of radiofrequency catheter ablation for the treatment of atrial fibrillation, electrophysiology laboratories have experienced a significant rise in the number of transseptal catheterization procedures. Traditionally, the procedure requires the presence of a interventional cardiologist who carries out transseptal catheterization following arterial puncture and placement of a reference pigtail catheter in the aortic root. Use of His bundle and coronary sinus catheters to provide anatomical and electrophysiological landmarks enables transseptal catheterization to be carried out without the need for arterial puncture or intracavity pressure measurement. We report our experience with transseptal catheterization in an electrophysiology laboratory using only electrophysiological landmarks. The procedure was carried out on 68 occasions and was successful in all patients except one, in whom catheterization could not be performed for anatomical reasons and because the patient had previously received anticoagulation therapy. One other patient developed transient ST elevation, which was probably due to an air embolism
