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Transbaffle/transconduit puncture using a simple CARTO‐guided approach without echocardiography in patients with congenital heart disease
Author(s) -
Laredo Mikael,
Waldmann Victor,
Soulat Gilles,
Amet Denis,
Marijon Eloi,
Iserin Laurence,
Ladouceur Magalie,
Zhao Alexandre
Publication year - 2020
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.14590
Subject(s) - medicine , ablation , fluoroscopy , intracardiac injection , radiology , catheter ablation , heart disease , catheter , surgery , cardiology
Catheter ablation (CA) of atrial tachyarrhythmias (ATs) in patients with complex congenital heart disease (CHD) often requires technically challenging transbaffle or transconduit puncture. The aim was to assess the feasibility and safety of transbaffle/transconduit puncture based on computed tomography (CT) three‐dimensional (3D) reconstruction merged with electro‐anatomical mapping (EAM) without per‐procedure echocardiographic guidance. Methods and Results We included 18 consecutive CHD patients in two centers who had atrial‐switch or Fontan surgery and underwent CA of AT by an antegrade approach requiring intracardiac puncture. Twelve patients with atrial‐switch surgery and six patients with extracardiac Fontan surgery were referred for CA of AT. Cardiac CT with 3D reconstruction was performed before the procedure. The 3D volume of the systemic venous atrium or extracardiac conduit acquired by EAM was merged with the corresponding CT 3D reconstruction. The ablation catheter was positioned at the optimal puncture site. Under fluoroscopic guidance, the needle was positioned next to the ablation and the puncture was performed. Balloon expansion of the puncture site was performed in every case of transconduit puncture and in two (17%) cases of transbaffle puncture. Overall, 17 intra‐atrial reentrant tachycarrythmias and 9 focal ATs were successfully ablated, with no acute complications. The median time to access the pulmonary atrium was 78.5 minutes (range, 55‐185) and total median fluoroscopy time was 23 minutes (range, 7‐53). Conclusions Transbaffle and transconduit punctures can be performed safely in CHD patients by using a simple technique relying on CT 3D reconstruction and EAM.