Abstract 17990: Reduction of Iatrogenic Atrial Septal Defects with Inferior Transseptal Puncture Site
Background: A residual iatrogenic atrial septal defect (ASD) after transseptal puncture is a frequent late complication, especially for a larger transseptal access. We hypothesized that utilizing a lower puncture site through the inferior limbus, guided by intracardiac ultrasound is safe, and may lead to a lower incidence of iatrogenic ASDs.
Methods: Single center retrospective analysis of 173 cases of cryoballoon ablation was performed where a 15-French sheath transseptal access was performed under the guidance of intracardiac echocardiography (ICE). Access through the membranous septum versus the inferior limbus was differentiated and analyzed. Doppler ICE was used to identify acute transseptal leaks after the transseptal sheath had been removed, as a predictor for possible iatrogenic ASD formation.
Results: Out of 173 transseptal puncture sites, 128 were through the inferior limbus, and 86 of 128 patients (67.2%) did not have acute Doppler flow after the removal of the 15-French transseptal sheath. There were no procedural complications. The remaining 45 transseptal puncture sites were through the membranous fossa, and 45 of 45 (100%) patients demonstrated an acute leak by Doppler ICE after transseptal sheath removal.
Conclusions: Selective transseptal puncture through the inferior limbus is safe for large sheath access and it significantly reduces the presence of a Doppler detectable leak. This may reduce the incidence of iatrogenic ASDs. Longer term follow-up is needed to compare the iatrogenic ASD closure rate.
- © 2012 by American Heart Association, Inc.