AccScience Publishing / BH / Online First / DOI: 10.36922/bh.5119
CASE SERIES

Intracardiac echocardiography-guided transseptal puncture in anteroinferior native septum site for patients undergoing atrial fibrillation ablation with atrial septal closure devices: A case series

Evan Jim Gunawan1,2 Hui Chai3 Zhanyang Wei4 Le Li1 Zhicheng Hu1 LiKun Zhou1 Yu Xia1 Xu Meng1 Lingmin Wu1 Lihui Zheng1 Ligang Ding1* Yan Yao1
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1 National Center for Cardiovascular Diseases, Fu Wai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
2 Department of Cardiovascular, Binawaluya Hospital Cardiac Centre, Jakarta, Indonesia
3 Department of Cardiovascular, The First People’s Hospital of Lanzhou City, Lanzhou, China
4 Department of Cardiovascular, Dongguan People’s Hospital, Guangdong, China
Submitted: 10 October 2024 | Revised: 15 November 2024 | Accepted: 27 November 2024 | Published: 10 December 2024
© 2024 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
Abstract

This case series describes the safety and feasibility of an anteroinferior transseptal puncture (TSP) in patients implanted with atrial septal defect (ASD) closure devices for atrial fibrillation (AF) ablation. Eight AF ablation procedures were performed in seven patients (58.4 ± 8.7 years; two males) with symptomatic AF and percutaneous ASD closure. Typically, the TSP site for patients with an ASD closure device is located in the inferior-posterior region of the native septum. However, with larger devices (>26 mm), limited space in this area can pose challenges for transseptal access. Using transthoracic echocardiography and 3D cardiac computed tomography, TSP sites were pre-determined, targeting the anteroinferior native septum. Closure device diameters averaged 23.8 ± 10.8 mm (range: 10 – 40 mm), with five cases involving devices ≥26 mm. The procedures were guided by fluoroscopy and intracardiac echocardiography, achieving a 100% success rate without TSP-related complications. These findings suggest the anteroinferior TSP approach is a safe and viable alternative for patients with large ASD closure devices.

Keywords
Atrial septal defect
Atrial septal closure device
Transseptal puncture
Atrial fibrillation
Ablation
Funding
This study was supported by the National High Level Hospital Clinical Research Funding (2023-GSP-GG-22) and the Clinical and Translational Medicine Research Project, Chinese Academy of Medical Sciences (2023- LC05).
Conflict of interest
Yan Yao is the Editor-in-Chief of this journal but was not in any way involved in the editorial and peer-review process conducted for this paper, directly or indirectly. Separately, other authors declared that they have no known competing financial interests or personal relationships that could have influenced the work reported in this paper.
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Brain & Heart, Electronic ISSN: 2972-4139 Published by AccScience Publishing