High Incidence of Echocardiographic Abnormalities of the Interatrial Septum in Patients Undergoing Ablation for Atrial Fibrillation

Abstract

A structurally abnormal IAS was diagnosed in nearly half of the patients undergoing ablation therapy for AF. The information obtained by TEE is mandatory to exclude left atrial thrombi prior the ablation procedure. Moreover, detailed knowledge of morphologic characteristics of the IAS facilitates an optimized and safe performance of the transseptal puncture using long sheaths with large diameters.

Characteristics and Catheter Ablation of Focal Atrial Tachycardia Originating From the Interatrial Septum

“…Whether septal AT originates from the right or the left side of the IAS is an important observation, since RF delivery from the opposite site may fail to eliminate the tachycardia despite the use of an irrigated catheter, probably because of the specific anatomy of the septum secundum formed by the infolding of two layers of atrial myocardium interspersed with variable thickness of adipose epicardial tissue, [7,10,16,17] resulting in variable thickness of the septum secundum. [26,27] Electroanatomical activation mapping of septal AT, irrespective of whether its origin is right-or left-sided, showed a centrifugal pattern originating from the IAS. However, the timing of the atrial electrogram relative to the P wave during AT often failed to discriminate a right-versus left-sided septal origin, because of the lack of an absolute discriminative value.…”

2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation

“…With careful, multiplanar inspection of the LAA and the number of LAA lobes, the TEE can also provide additional information to help guide the procedure, such as identification of a pre-existing pericardial effusion, globally impaired cardiac function, presence of an atrial septal defect (ASD) or persistent foramen ovale, or fibrosis of the interatrial septum after previous ablation. 809 , 810 , 811 In addition, LA anatomical features, such as a thickened ridge toward the left PVs, PV stenosis or occlusion, or cor triatriatum, can be identified.…”

Novel Solutions Applied in Transseptal Puncture: A Systematic Review

“…Some authors proposed pre-interventional planning techniques, namely: identification of a safe zone for TSP [32,[53][54][55] and recognition of the optimal puncture position, which guarantee maximum catheter dexterity inside the LA [56]. This planning step relies on preinterventional image acquisitions, namely, by: CT [53,54,56], MR [56] or TEE [32,55]. The authors agreed that these novel planning methods allow accurate planning of the TSP therefore, increasing the safety of TSP and reducing complication/failures rate [53,56].…”

“…The novel pre-procedural planning methods for TSP focused on pre-interventional imaging, specifically: CT [53,56], MR [56] or TEE [32,55]. Wagdi et al reported that TSP is challenging in situations where larger device sizes (e.g.…”

“…This study was performed on 20 patients, and the results proved that CT data can predict the feasibility and safety of TSP. Similarly, Schernthaner et al used TEE to predict the feasibility of TSP, proving that TEE can be used to identify patients with abnormal IAS wall anatomy [55]. Tomlinson et al suggested that FO thickness is a predictor of the difficulty of TSP procedure.…”