0382 : Intracavitary echocardiography (ICE) to guide trans-septal puncture in electrophysiological procedures

Introduction During ablation procedures in the left atrium (LA), safe puncture of the septum requires precise localization of the fossa ovalis (FO). An intracavitary echocardiography (ICE) catheter positioned in the right atrium provides clear visualization of the interatrial septum and FO. The aim of this multicenter observational study was to assess the feasibility of trans-septal puncture under ICE guidance and its impact on procedure length. Methods This is an observational study conducted during one year in 8 centers specialized in ablation techniques requiring a trans-septal approach. The following data were collected amongst other things: time required for trans-septal catheterization, length of the FO to the LA wall before advancement of the trans-septal dilator, distance when maximum tenting of the FO by the trans-septal dilator, complications occurring during or at distance from the procedure. Results The study population included 123 patients (M 72%; mean age 60±10 years). Median times were as following: to prepare ICE catheter, 70 sec (38; 115); to insert ICE into the sheath, 40 sec (21; 88); to reach the LA, 153 sec (69; 310); time of fluoroscopy duration was 142 sec (80;256). Length of the FO was 16 ± 5 mm, distance from the FO to the LA wall before advancement of the trans-septal dilator was 29 ± 9 mm, distance when maximum tenting of the FO by the trans-septal dilator 15.9 ± 9 mm. Pericardial effusions occurred in 10 patients: 1 severe tamponade necessitating pericardial puncture (FO was not visible with ICE), 6 moderate per procedure and 3 light delayed pericardial effusions (not related to trans septal puncture). Conclusion This observational study shows that ICE does not add a long additional time to ablation procedure. It gives a direct indication of the position of the FO and the length of the LA. Although a tamponade occurred in one patient (0.8%), this technique is helpful in procedures requiring a transseptal approach. The author hereby declares no conflict of interest