Journal: Europace
Article Title: Transseptal puncture and catheter ablation of atrial fibrillation in patients with atrial septal occluder devices: procedural techniques and outcomes
doi: 10.1093/europace/euag071
Figure Lengend Snippet: Step-by-step procedural sequence of TSP through an ASO device. ( A ) RA angiography (LAO fluoroscopic view) delineates the interatrial septum and the ASO device relationship. ( B ) The optimal puncture area is located at the 5–7 o’clock position on the device under the RAO fluoroscopic view (shaded area). ( C ) A puncture is performed using a mechanical transseptal needle inserted into an SL-0 sheath. ( D ) After confirming LA entry by contrast injection, a 0.014-inch guidewire is advanced into the LA. If the tip of the inner dilator in the sheath can be advanced into the LA at this point, the needle and 0.014-inch guidewire should be exchanged for a 0.032-inch guidewire. ( E ) Initial dilation is performed using a 4–5 mm balloon. ( F ) If the sheath cannot penetrate the ASO device, balloon is upsized to 6–8 mm. ( G ) The sheath is advanced into the LA while the balloon is being deflated (the deflate-and-dive technique). ( H ) Using a 0.032-inch guidewire, the SL-0 is exchanged for a steerable sheath. ( I ) Then, an ablation catheter is inserted into the steerable sheath, and the ablation procedure is initiated. ASO, atrial septal occlude; LA, left atrium; LAO, left anterior oblique; RA, right atrium; RAO, right anterior oblique; TSP, transseptal puncture.
Article Snippet: A SwartzTM SL-0 sheath (8.5 Fr, 63 cm, Abbott) was advanced to the RA surface of the ASO device at the defined puncture area.
Techniques: Sequencing, Injection