Page 86 - BH-3-3

Brain & Heart Anteroinferior native septum TSP with ASD Device

patients with atrial septal ASD closure device was 77.7%,
and comparing native TSP versus TSP on the ASD closure
Abbreviations: AF: Atrial fibrillation; CTI: Cavotricuspid isthmus; LA: Left atrium; LVEF: Left ventricular ejection fraction; PAF: Paroxysmal atrial fibrillation; PeAF: Persistent atrial fibrillation;
Case 8 67 Female 40 PeAF 46 65 Single puncture Antero-inferior 12 PVI + roof line 45 3 No device, no significant difference in recurrence of AF. 11
3.1. Intracardiac echocardiography and selection of
puncture site
Single puncture Antero-inferior 5 PVI + posterior box line 42 3 Yes To mitigate the risk of complications, the TSP should
Female
be performed under transesophageal echocardiography
Case 7 or ICE guidance. In our series of cases, we used ICE to
PeAF
41
12
77
70
select the puncture site and advanced the needle and the
sheath from the right atrium to the LA. Ensuring accurate
visualization of the native septum and its relationship with
Case 6 46 Female 26 PAF 36 58 Single puncture Antero-inferior 6 PVI + anterior line + CTI 36 3 No adjacent structures is crucial to avoid complications. An
anteriorly directed ICE view will demonstrate the anterior
LA structures, including the mitral valve and LAA, with
the aortic root. A more posterior view will show the left
pulmonary veins, but in this view, there is usually not
Case 5 52 Female 34 PAF 47 64 Single puncture Antero-inferior 7 PVI + posterior box line 38 22 No enough native septum if the device is large.
When the sheath and the dilator are positioned in the
native septum, careful attention should be paid to ensuring
that the transseptal needle is not directed toward the aortic
Single puncture Antero-inferior 4 PVI 31 11 No and inferiorly, away from the aortic root, to avoid inadvertent
root. The puncture site should be situated more posteriorly
Case 4 puncture. In the inferior area, care should be taken not to
PeAF
Male
38
14
62
56
puncture too low, avoiding puncture of the coronary sinus.
There was a report describing successful TSP procedures
performed even in the presence of a large closure device
Case 3 46 Female 26 PAF 36 66 Single puncture Antero-inferior 6 PVI + roof line 20 3 Yes (30 mm), but the puncture site was in the posteroinferior
12
site of the native septum. The anteroinferior site of the TSP
approach can also be applied for not only radiofrequency
(RF) ablation but also pulse field ablation. In this case
13
series, based on 3D reconstruction cardiac CT scan, we
Single puncture Antero-inferior 6 PVI 19 7 Yes found that the anteroinferior site of the native septum
Case 2 Female featured more area not covered by the closure device
PAF
64
66
34
28
compared to the posteroinferior site, even when a very
large device was used (40 mm). Our findings underscore
imaging guidance in navigating AF ablation, with the aim
Case 1 54 Male 10 PAF 35 68 Single puncture Antero-inferior 4 PVI 32 6 Yes the importance of procedural planning and meticulous
of ensuring procedural safety and efficacy.
Table 1. Baseline clinical characteristics Size of closure device (mm) Location of TSP TSP duration (minutes) AF ablation strategy RF ablation duration (minutes) Follow-up after AF ablation (months) AF recurrence after ablation RF: Radiofrequency; TSP: Transseptal puncture. sample and entailed a relatively short duration in follow-up
Several limitations of this report should be
acknowledged. This case series includes a relatively small
of patients. This case series with relatively small samples,
and a relatively short duration of follow-up. In this case
series, we did not compare between puncturing the native
septum in the anteroinferior or posteroinferior site and
direct puncture to the device in patient AF ablation.
4. Conclusion
Type of AF
Age (years)
Gender
cardiac CT scan provides valuable information about

Volume 3 Issue 3 (2025) LA size (mm) LVEF (%) TSP 4 Pre-procedural imaging such as 3D reconstruction
doi: 10.36922/bh.5119