Transseptal left heart catheterization for cardiac ablation procedures

Transseptal left heart catheterization has been performed as an alternative to the retrograde approach since 1958. However, this procedure can result in life-threatening complications, some of which may occur because of insuf ficient anatomical landmarks. Accordingly, we sought to assess the safety a nd efficacy of a new transseptal left heart catheterization technique desig ned for ablation procedures. Specifically, we examined whether electrode ca theters could be used as anatomical landmarks, permitting identification of the aortic root and other critical structures. Results: One hundred and eight consecutive patients underwent transseptal l eft heart catheterization under biplane fluoroscopy during catheter ablatio n. Electrode catheters positioned in the right atrial appendage, His bundle region, and coronary sinus were used as anatomical landmarks to guide the transseptal unit to the fossa ovalis. The angles of the right anterior and left anterior oblique projections were selected in each patient based on th e orientation of the His bundle and coronary sinus catheters. Transseptal l eft heart catheterization was successfully performed in all patients withou t complications. In contrast to previous reports, the direction of the need le at the successful puncture site in the last 96 patients varied substanti ally: 2 o'clock in 13 patients (13%); 3 o'clock in 43 patients (45%); and 4 o'clock in 40 patients (42%). Conclusion: The use of electrode catheters as anatomical landmarks and bipl ane fluoroscopy facilitates transseptal catheterization. This approach can be used safely during catheter ablation procedures.