HeartRhythm Case Reports

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Date of download: 5/29/2016 Copyright © The American College of Cardiology. All rights reserved. From: Emerging Applications for Transseptal Left Heart.

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Presentation transcript:

HeartRhythm Case Reports Transseptal puncture facilitated by “reverse tenting” using a left atrial ablation catheter Mohammadali Habibi, MD, Joshua M. Cooper, MD, FHRS, Charles J. Love, MD, FHRS, Sunil K. Sinha, MD, FHRS HeartRhythm Case Reports DOI: 10.1016/j.hrcr.2018.12.002 Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 1 Left anterior oblique view after transseptal puncture with Brockenbrough needle. Injection of contrast through the needle shows extravasation of contrast into pericardial space (white arrows). HeartRhythm Case Reports DOI: (10.1016/j.hrcr.2018.12.002) Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 2 A: Intracardiac echocardiographic image showing marked tenting of the intra-atrial septum against the needle during the first transseptal puncture. B: Intracardiac echocardiographic image showing prolapsed ablation catheter tip artifact at the membranous fossa ovalis causing “reverse tenting.” Left anterior oblique (LAO) (C) and right anterior oblique (RAO) (D) images after the second transseptal puncture showing the curved ablation catheter against the intra-atrial septum and injected contrast within the left atrium well away from the free wall. HeartRhythm Case Reports DOI: (10.1016/j.hrcr.2018.12.002) Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 3 Left anterior oblique (LAO) (A) and right anterior oblique (RAO) (B) fluoroscopic images with curled ablation catheter backward traction being applied on the left atrial side of the interatrial septum, thereby enabling an SL-1 introducer and sheath to reach the interatrial septum. Intracardiac echocardiographic images showing the ablation catheter tightly curved in the left atrium and pulled back onto the left side of the interatrial septum (C), and a more posterior view of the septum showing reverse tenting of the superior portion of the interatrial septum from backward traction on the curved ablation catheter, while the SL-1 dilator is seen tenting the septum toward the left atrium in a more caudal and posterior location than the first transseptal site (D). HeartRhythm Case Reports DOI: (10.1016/j.hrcr.2018.12.002) Copyright © 2018 Heart Rhythm Society Terms and Conditions