Safety and efficacy of trasseptal puncture for electrophysiological procedures by visualization of aorta with pigtail catheter

Since it was first reported in 1959, several techniques have been employed to facilitate transseptal puncture (TP) for left atrial (LA) catheterization and ablation. Cardiac tamponade and aortic injury are still main complications of TP. Visualization of ascending aorta by placing pigtail catheter (PTC) in non-coronary sinus (NCS) was in use by invasive cardiologists for years. In electrophysiological (EP) world, however, this simple and cheap technique is not in wide use.

We report the retrospective data of 217 consecutive patients (pts) who underwent TP for EP procedures in our department since 2014. In 97.2% of them PTC was inserted via radial artery and placed in NCS. Invasive arterial blood pressure was achieved as well.

Baseline characteristics: The median age of our pts was 65 years old. 31.3% of them were females. The rate of diabetes mellitus was 30.5%, hypertension 60.1%, history of heart failure 18.5%, renal failure 13.8%, coronary artery disease 24.1%, obesity 29.6%, old stroke 14.8%, significant valvular disease 10.1% and implanted pacemaker or defibrillator 4.6%. The mean LA diameter was 40.8±5.7 mm and mean left ventricle ejection fraction was 61.1±5.7%.

Results: 12.4% of the pts underwent PVAC procedure, 38.7% Cryo-Balloon pulmonary vein isolation (PVI), 15.2% point-by-point PVI with Carto system, 5.5% LA atrial flutter or atrial tachycardia ablation with Carto system, 16.5% left atrial appendage closure, 14.2% LA accessory pathways ablation. Redo PVI with recurrent TP was performed in 10.6%. Double TSP was used in a half of them. During the TSP ICE was used in 1% of the cases, TEE in 16.5% and the Safesept needle-wire in 12%. There was no one case of tamponade or aortic puncture in our pts.

Conclusion: The placement of pigtail catheter in NCS of aorta via radial artery could be effective, cheap and safe tool during TP for EP procedures.