Non-Fluoroscopic Transseptal Catheterization During Electrophysiology Procedures using a Remote Magnetic Navigation System

Transseptal punctures are commonly performed, and left atrial (LA) access is frequently lost during lengthy, complex electrophysiology (EP) procedures. We describe a new technique for non-fluoroscopic re-crossing the fossa ovalis using a new multielectrode transseptal sheath (TS) and a new remote magnetic catheter navigation system (RMNS) (CGCI System, Magnetecs) that uses 8 rapid external electromagnets for real-time navigation of a magnet-tipped electrode catheter across the initial transseptal puncture site in 5 patients undergoing left-sided ablation procedures. The three-dimensional (3D) position of a 8.5 Fr steerable TS with 5-ring 5-15-15-5-mm spaced distal electrodes (Agilis ES©, St Jude Medical), and site of fossal ovalis crossing were "shadowed landmarks" on a 3D electroanatomic mapping (EAM) system (EnSite/NavXTM, St Jude Medical). The TS-magnetic ablation catheter assembly was pulled-back to the inferior vena cava. EAM landmarks were used with RMNS-guided "manual" and "automated" catheter navigation modalities, until septal crossing was obtained. Transseptal re-crossing was successfully performed in all patients in 6.2±8.1 sec using the "automated" RMNS-guided technique and in 30.4±28.4 sec using the "manual" RMNS-guided technique (p=0.01) without complications. This new RMNS was safely and effectively used to perform non-fluoroscopic transseptal catheterization.