Document Detail


Use of a novel needle wire in patients undergoing transseptal puncture associated with severe septal tenting.
MedLine Citation:
PMID:  20072804     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: An increasing number of patients undergo left atrial ablation procedures, since several approaches have proven efficacy in the treatment of atrial fibrillation. Although transseptal catheterization was generally shown be a safe technique, it harbors the principal risk of cardiac injury. Therefore, there is a need for a safe and effective tool to enable transseptal puncture in difficult cases as well. METHODS AND RESULTS: In 158 consecutive patients, a transseptal puncture was intended for mapping and ablation of left atrial tachycardias. In seven patients of this series transseptal puncture using different sheaths and needle designs, the operators failed to cross the interatrial septum as a result of severe tenting. Three patients were known to have a septal aneurysm; a redo procedure was performed in two patients. In the remaining patients, there was no obvious explanation for the difficulty in crossing the interatrial septum conventionally. In all seven patients, a 120-cm-long nitinol guidewire ("needle wire") with a 0.014-inch diameter was used to cross the atrial septum with the following idea: after tenting the fossa ovalis with the transseptal dilator and the Brockenbrough needle positioned just inside the tip, effortless advancement of the needle wire perforates the membranous fossa. Unsupported by the needle and dilator, the tip of the wire immediately assumes a "J" shape, rendering it incapable of further tissue penetration after its entry into the left atrium. In all seven patients, the needle wire could be placed into a left pulmonary vein. In five patients, a single attempt was sufficient to reach the left atrium with the wire, two patients needed two and three attempts, respectively. No complications occurred. CONCLUSIONS: Additional use of a needle wire to perform transseptal puncture in a subset of patients at higher risk for complications appears safe and effective.
Authors:
Marcus Wieczorek; Reinhard Hoeltgen; Elvan Akin; Ali Reza Salili
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing     Volume:  27     ISSN:  1572-8595     ISO Abbreviation:  J Interv Card Electrophysiol     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-03-18     Completed Date:  2010-06-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9708966     Medline TA:  J Interv Card Electrophysiol     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  9-13     Citation Subset:  IM    
Affiliation:
Department of Electrophysiology, Herzzentrum Duisburg, Gerrickstrasse 21, 47137 Duisburg, Germany. drmwieczorek@t-online.de
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MeSH Terms
Descriptor/Qualifier:
Atrial Fibrillation / diagnosis*,  epidemiology,  surgery*
Body Surface Potential Mapping / instrumentation*,  statistics & numerical data
Catheter Ablation / instrumentation*,  statistics & numerical data
Equipment Design
Equipment Failure Analysis
Female
Germany / epidemiology
Heart Septum / surgery*
Humans
Male
Middle Aged
Needles / statistics & numerical data*
Prevalence
Punctures / instrumentation*,  statistics & numerical data
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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