Wire- and needle potentials facilitating transseptal puncture

Abstract Background Transseptal puncture for left heart interventions became a routine procedure guided by fluoroscopy and echocardiography. The use of intracardiac potentials derived from the sheath-transseptal-needle/guidewire-combination may provide helpful information to increase safety of this procedure. Methods and results We recorded the intracardiac potentials from the sheath-transseptal-needle/guidewire-combination during the transseptal puncture procedure in 31 consecutive patients (mean age 67.2 ± 8.2 years; 21 in sinus rhythm, 10 in atrial fibrillation) designated for ablation of atrial fibrillation by the Cryo-balloon ® technique (Medtronic, Minnesota, USA). The EP-Navigator ® 3-D-image integration tool (Philips Healthcare, Hamburg, Germany) was used for visualisation of the device position in relation to the cardiac structures. Typical and reproducible potentials could be derived in all patients for the different device localisations at transseptal puncture procedure. Especially the transition from the muscular interatrial septum into the fossa ovalis could be easily depicted by the changes both of morphology and magnitude of the atrial signal (6.1 ± 2.3 mV in sinus rhythm [SR] / 3.5 ± 0.9 mV in atrial fibrillation [AF] at the muscular interatrial septum and 0.5 ± 0.2 mV in SR / 0.5 ± 0.1 mV in AF in the fossa ovalis). Conclusions The crucial steps of a transseptal procedure can be verified by typical changes (morphology and amplitude) of the intracardiac signals derived from the sheath-transseptal-needle/guidewire-combination in patients with sinus rhythm as well as in atrial fibrillation. Condensed Abstract. Background. The use of intracardiac potentials derived from the sheath-transseptal-needle/ guidewire-combination may provide helpful information on device position to increase the safety of transseptal puncture procedures. Methods and results. We recorded the intracardiac signals derived from the sheath-transseptal-needle/guidewire-combination during the transseptal puncture procedure for ablation of atrial fibrillation in 31 patients. Typical and reproducible potentials could be derived in all patients for the different device localisations. Conclusions. The crucial steps of a transseptal procedure can be verified by typical changes of magnitude and morphology of the intracardiac signals derived from the sheath-transseptal-needle/guidewire-combination.