Intracardiac echocardiography-guided transseptal puncture in anteroinferior native septum site for patients undergoing atrial fibrillation ablation with atrial septal closure devices: A case series

Abstract

This case series describes the safety and feasibility of an anteroinferior transseptal puncture (TSP) in patients implanted with atrial septal defect (ASD) closure devices for atrial fibrillation (AF) ablation. Eight AF ablation procedures were performed in seven patients (58.4 ± 8.7 years; two males) with symptomatic AF and percutaneous ASD closure. Typically, the TSP site for patients with an ASD closure device is located in the inferior-posterior region of the native septum. However, with larger devices (>26 mm), limited space in this area can pose challenges for transseptal access. Using transthoracic echocardiography and 3D cardiac computed tomography, TSP sites were pre-determined, targeting the anteroinferior native septum. Closure device diameters averaged 23.8 ± 10.8 mm (range: 10 - 40 mm), with five cases involving devices ≥26 mm. The procedures were guided by fluoroscopy and intracardiac echocardiography, achieving a 100% success rate without TSP-related complications. These findings suggest the anteroinferior TSP approach is a safe and viable alternative for patients with large ASD closure devices.

Keywords

Atrial septal defect / Atrial septal closure device / Transseptal puncture / Atrial fibrillation / Ablation

Acknowledgments

None.

Funding

This study was supported by the National High Level Hospital Clinical Research Funding (2023-GSP-GG-22) and the Clinical and Translational Medicine Research Project, Chinese Academy of Medical Sciences (2023- LC05).

Conflict of interest

Yan Yao is the Editor-in-Chief of this journal but was not in any way involved in the editorial and peer-review process conducted for this paper, directly or indirectly. Separately, other authors declared that they have no known competing financial interests or personal relationships that could have influenced the work reported in this paper.

Author contributions

Conceptualization: Evan Jim Gunawan, Lihui Zheng, Ligang Ding, Yan Yao

Investigation: Evan Jim Gunawan, Hui Chai, Zhanyang Wei, Ligang Ding

Writing - original draft: Evan Jim Gunawan, Hui Chai, Le Li, Zhicheng Hu, Likun Zhou, Ligang Ding

Writing - review & editing: Evan Jim Gunawan, Yu Xia, Xu Meng, Lingmin Wu, Ligang Ding

Ethics approval and consent to participate

This study was approved by the Ethics Committee of Fuwai Hospital, Chinese Academy of Medical Science (Approval ID: 2022-1705). Written informed consent was obtained from all participating patients before their inclusion in the study.

Consent for publication

Written informed consent was obtained from all patients for the release of their data and/or images included in this publication.

Availability of data

Not applicable.

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