Intracardiac echocardiography to guide transseptal left heart catheterization for radiofrequency catheter ablation

Transseptal Catheterization. Introduction: The purpose of this study was to assess the feasibility and safety of intracardiac echocardiography to guid e transseptal puncture for radiofrequency catheter ablation, Methods and Results: Transcatheter intracardiac echocardiography (9 MHz) wa s utilized to guide transseptal puncture in 53 patients undergoing radiofre quency catheter ablation, The anatomy and relationship of intra- and extrac ardiac structures were visualized with the ultrasound transducer positioned at the fossa ovalis, The tip of the transseptal dilator and tenting of the fossa ovalis and the left atrial wall were simultaneously visualized in a single ultrasound image in all patients. With maximum tenting of the fossa ovalis, the mean distance from the fossa to the left atrial wall was 11.9 /- 5.8 mm (range: 1.8 to 25.6 mm), In four patients (8%), the tented fossa ovalis abutted the left atrial wall and the transseptal dilator was redirec ted with ultrasound guidance. Puncture of the interatrial septum was achiev ed through the fossa ovalis in each patient and required a single attempt i n 51 patients (96%), The mean number of punctures per patient was 1.1 +/- 0 .4, The mean time to perform transseptal catheterization was 18.2 +/- 6.8 m inutes. There were no complications. Conclusion: Intracardiac echocardiography delineated the anatomy of intra- and extracardiac structures not identified with fluoroscopy and simplified correct positioning of the transseptal dilator, puncture of the fossa ovali s, and cannulation of the left atrium in a timely and uncomplicated fashion .