Author + information
- Received December 16, 2019
- Revision received February 18, 2020
- Accepted March 10, 2020
- Published online May 18, 2020.
- Ronghui Yu, MDa,b,∗ (, )@AnzhenEp@YaleCardiology,
- Nian Liu, MDa,b,
- Jun Lu, MDc,
- Xin Zhao, MDa,b,
- Yucai Hu, MDd,
- Jianqiang Zhang, MDe,
- Fengqiang Xu, MDc,
- Ribo Tang, MDa,b,
- Rong Bai, MDa,b,
- Joseph G. Akar, MDf,
- Jianzeng Dong, MDa,b,g and
- Changsheng Ma, MDa,b
- aDepartment of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- bNational Clinical Research Center for Cardiovascular Diseases, Beijing, China
- cDepartment of Cardiology, Affiliated Hospital of Qingdao University, Qingdao, China
- dDepartment of Cardiology, First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, China
- eDepartment of Cardiology, Shanghai East Hospital, Tongji University, Shanghai, China
- fSection of Cardiology, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut
- gCardiovascular Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- ↵∗Address for correspondence:
Dr. Ronghui Yu, Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Beijing 100029, China.
Objectives This study sought to define electrographic characteristics of the fossa ovalis (FO) and use these findings in developing a 3-dimensional (3D) transseptal puncture (TSP) technique that does not rely on fluoroscopy or echocardiography.
Background Traditional TSP method based on fluoroscopy or echocardiography is basically a 2-dimensional (2D) technique. A valid 3D method of TSP has not been sufficiently clarified.
Methods The shape of the FO and its center were “electrographically” defined by comparing their potential characteristics to those of the surrounding limbus. After validation by intracardiac echocardiography, this FO mapping was incorporated into 3D electroanatomical reconstruction of the right atrium. Using a new catheter connection, the transseptal needle could be visualized nonfluoroscopically and directed to the precise localization of the FO on the electroanatomic map.
Results A total of 276 patients who underwent atrial fibrillation ablation were included. The central FO was identified in all cases with atrial electrogram voltage at 0.33 ± 0.21 mV. The amplitude of atrial potential at the FO annulus was 1.70 ± 0.72 mV (p < 0.001). By incorporating the electrographically defined FO into the 3D electroanatomic mapping and using the transseptal needle visualization approach, TSP was successful in all patients, with 91% of the cases at the first attempt. Atrial fibrillation ablation was completed in all patients with no major complication.
Conclusions Electrographic characteristics of the FO center are distinct from those of the surrounding regions. This information can be leveraged to define the FO on 3D electroanatomic mappings, thereby facilitating safe TSP without the need of ancillary imaging with fluoroscopy or echocardiography.
This work was supported by the National Key Research and Development Program of China (2018YFC1312500 [to Dr. Bai], 2017YFC0908803 [to Dr. Tang]), the Beijing Municipal Science and Technology Commission (Z181100001718174 [to Dr. Yu]), and the National Science Foundation of China (81530016 [to Dr. Ma]). Dr. Ma has received lecture honoraria from Bristol-Myers Squibb, Pfizer, Johnson & Johnson, Boehringer Ingelheim, Bayer, and AstraZeneca. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Interventions author instructions page.
- Received December 16, 2019.
- Revision received February 18, 2020.
- Accepted March 10, 2020.
- 2020 American College of Cardiology Foundation
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