TY - JOUR
T1 - Bailout Atrial Balloon Septoplasty to Overcome Challenging Left Atrial Transseptal Access for Catheter Ablation of Atrial Fibrillation
AU - Liang, Jackson J.
AU - Mohanty, Sanghamitra
AU - Fahed, Joe
AU - Muser, Daniele
AU - Briceno Gomez, David F.
AU - Burkhardt, J. David
AU - Arkles, Jeffrey S.
AU - Supple, Gregory E.
AU - Frankel, David S.
AU - Nazarian, Saman
AU - Garcia, Fermin C.
AU - Callans, David J.
AU - Dixit, Sanjay
AU - Di Biase, Luigi
AU - Natale, Andrea
AU - Marchlinski, Francis E.
AU - Santangeli, Pasquale
N1 - Funding Information:
Dr. Nazarian has served as a consultant for Biosense Webster, CardioSolv, and Siemens; and has received research grant support from Biosense Webster. Dr. Di Biase has served as a consultant for Biosense Webster, Stereotaxis, Boston Scientific, and Abbott; and has received speaker/travel honoraria from Medtronic, Pfizer, and Biotronik. Dr. Natale has received consulting fees/honoraria from Biosense Webster, Inc., St. Jude Medical, Medtronic, and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2018 American College of Cardiology Foundation
PY - 2018/8
Y1 - 2018/8
N2 - Objectives: This study reports outcomes of bailout atrial balloon septoplasty (ABS) to overcome challenging left atrial (LA) access in patients undergoing atrial fibrillation (AF) ablation. Background: Transseptal puncture (TSP) and LA access for AF ablation can be challenging in patients with prior atrial septal surgery, percutaneous closure, or scarred septum due to multiple prior TSPs. Methods: The study identified patients who underwent AF ablation at 2 ablation centers from 2011 to 2017 with challenging TSP in whom bailout percutaneous ABS was performed to allow LA access. Following TSP, the transseptal sheath could not be advanced to the LA despite multiple attempts or approaches including use of a stiff wire sequentially in the left and right pulmonary veins, use of a stiff pigtail exchange wire advanced in the LA or left ventricle, or sequential dilation with progressively larger diameter long dilators. ABS was performed using a noncompliant balloon (diameter 4 to 10 mm) advanced over a stiff wire deployed in the left superior pulmonary vein, allowing passage of the transseptal sheaths for completion of the AF ablation procedure. Results: Fifteen patients (mean age 54.4 ± 15.5 years, 9 women) with challenging TSP (7 patients with prior surgical ASD repair, 2 with percutaneous ASD closure devices, and 13 with ≥1 previous TSP) underwent bailout ABS for AF ablation. After TSP (radiofrequency assisted in 10 cases), ABS was successful and permitted access to the LA for ablation in all patients. Mean time required to perform ABS was 21.3 ± 19.4 min, and mean total procedure time was 241.1 ± 114.6 min (fluoroscopy time 62.0 ± 29.9 min). There were no procedural complications. Conclusions: In patients undergoing AF ablation with difficult transseptal access due to scarred, surgically, or percutaneously repaired atrial septum, ABS is a safe and effective bailout strategy to obtain transseptal access.
AB - Objectives: This study reports outcomes of bailout atrial balloon septoplasty (ABS) to overcome challenging left atrial (LA) access in patients undergoing atrial fibrillation (AF) ablation. Background: Transseptal puncture (TSP) and LA access for AF ablation can be challenging in patients with prior atrial septal surgery, percutaneous closure, or scarred septum due to multiple prior TSPs. Methods: The study identified patients who underwent AF ablation at 2 ablation centers from 2011 to 2017 with challenging TSP in whom bailout percutaneous ABS was performed to allow LA access. Following TSP, the transseptal sheath could not be advanced to the LA despite multiple attempts or approaches including use of a stiff wire sequentially in the left and right pulmonary veins, use of a stiff pigtail exchange wire advanced in the LA or left ventricle, or sequential dilation with progressively larger diameter long dilators. ABS was performed using a noncompliant balloon (diameter 4 to 10 mm) advanced over a stiff wire deployed in the left superior pulmonary vein, allowing passage of the transseptal sheaths for completion of the AF ablation procedure. Results: Fifteen patients (mean age 54.4 ± 15.5 years, 9 women) with challenging TSP (7 patients with prior surgical ASD repair, 2 with percutaneous ASD closure devices, and 13 with ≥1 previous TSP) underwent bailout ABS for AF ablation. After TSP (radiofrequency assisted in 10 cases), ABS was successful and permitted access to the LA for ablation in all patients. Mean time required to perform ABS was 21.3 ± 19.4 min, and mean total procedure time was 241.1 ± 114.6 min (fluoroscopy time 62.0 ± 29.9 min). There were no procedural complications. Conclusions: In patients undergoing AF ablation with difficult transseptal access due to scarred, surgically, or percutaneously repaired atrial septum, ABS is a safe and effective bailout strategy to obtain transseptal access.
KW - angioplasty
KW - atrial fibrillation
KW - balloon
KW - catheter ablation
KW - septoplasty
KW - septostomy
KW - transseptal
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U2 - 10.1016/j.jacep.2018.04.003
DO - 10.1016/j.jacep.2018.04.003
M3 - Article
C2 - 30139482
AN - SCOPUS:85047332551
SN - 2405-500X
VL - 4
SP - 1011
EP - 1019
JO - JACC: Clinical Electrophysiology
JF - JACC: Clinical Electrophysiology
IS - 8
ER -