TRANSSEPTAL APPROACH TO ABLATION OF LEFT-SIDED ARRHYTHMIAS DOES NOT LEAD TO PERSISTING INTERATRIAL SHUNT - A TRANSESOPHAGEAL ECHOCARDIOGRAPHIC STUDY

In experienced hands, antegrade left heart catheterization via a trans eptal puncture is a safe and effective method of performing radiofrequ ency ablation on the left side of the heart. Persistence of atrial sep tal defect following transeptal puncture for mitral valvuloplasty has been widely reported although hemodynamically significant shunts are r are. To investigate the persistence of interatrial shunt following tra nseptal puncture in patients undergoing left-sided electrophysiologica l procedures using TEE. Fifty-one adult patients, 20 men, aged 19-82 ( mean 42.4) years underwent 55 transeptal punctures. Either an 8 Fr Mul lins or 8 Fr Swartz transeptal sheath was deployed in all cases. Of th ese, 28 consecutive patients were approached and 20 consented to under go TEE. TEE was performed at least 3 weeks post transeptal puncture us ing a single-plane transducer for the first 18 patients, superseded by a multiplane transducer for the later cases. Both color flow Doppler and microcavitation contrast imaging of the interatrial septum rr ere performed. One patient in the single-plane transducer group was exclud ed as she failed to swallow the TEE probe. In the remaining 25 patient s studied, 9 men aged 21-82 (mean 44.1) years, TEE was performed at a mean of 12.2 (range 3-52) weeks post procedure. No evidence of interat rial shunt rt as detected by either color flow or contrast studies. Tr anseptal puncture used in electrophysiological procedures does not res ult in interatrial shunts persisting > 3 weeks post procedure.