Intracardiac echocardiography to guide transseptal catheterization for radiofrequency catheter ablation of left-sided accessory pathways: two case reports

Abstract

Intracardiac echocardiography (ICE) is a useful tool for guiding transseptal puncture during electrophysiological mapping and ablation procedures. Left-sided accessory pathways (LSAP) can be ablated by using two different modalities: retrograde approach through the aortic valve and transseptal approach with puncture of the fossa ovalis. We shall report two cases of LSAP where transcatheter radiofrequency ablation (TCRFA) was firstly attempted via transaortic approach with ineffective results. Subsequently, a transseptal approach under ICE guidance has been performed. During atrial septal puncture ICE was able to locate the needle tip position precisely and provided a clear visualization of the "tenting effect" on the fossa ovalis. ICE allowed a better mapping of the mitral ring and a more effective catheter ablation manipulation and tip contact which resulted in a persistent and complete ablation of the accessory pathway with a shorter time of fluoroscopic exposure. ICE-guided transseptal approach might be a promising modality for TCRFA of LSAP.

Intracardiac Echo‐Guided Radiofrequency Catheter Ablation of Atrial Fibrillation in Patients with Atrial Septal Defect or Patent Foramen Ovale Repair: A Feasibility, Safety, and Efficacy Study

“…The utility of ICE during AF ablation has been well documented 23–27 . ICE provides important anatomical details of the interatrial septum, PV antra, and the relationship between the esophagus and left atrial posterior wall.…”

Preventing complicated transseptal puncture with intracardiac echocardiography: case report

“…It serves not only scientific purposes but practical issues as well. Its value for achieving successful and uncomplicated transseptal access to the LA cavity is well known [1-4]. However, it has not been used consistently for elucidating the possible mechanisms of mechanical complications during transseptal left heart procedures.…”

The use of echocardiography in Wolff–Parkinson–White syndrome

“…ICE is particularly useful for guiding transseptal puncture during mapping and ablation procedures for left-sided accessory pathways [11,64]. It can locate the needle tip position precisely and provides clear visualization of the ''tenting effect'' on the fossa ovalis.…”

“…In the past decades, with technical improvement, echocardiography has emerged as an investigational tool to predict accessory pathway location in WPW syndrome with satisfactory accuracy [5][6][7][8][9]. In addition, echocardiography has been used to guide the ablation procedure [10][11][12], and to provide crucial information about co-existent cardiac abnormalities [6,13], cardiac function [14][15][16][17][18], and procedural complications [19,20]. This review summarizes the current use of echocardiography in WPW syndrome.…”