Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Dec;32(12):3270-3274.
doi: 10.1111/jce.15272. Epub 2021 Oct 24.

A reliable fossa ovalis impedance mapping for safer transseptal puncture: A new vision beyond voltage

Francesco Pentimalli  1   2 , Stefano Cornara  1   2 , Matteo Astuti  1   2 , Luca Bacino  1   2 , Alberto Somaschini  2 , Paolo Mazzucchi  3 , Elisa Buscaglia  2 , Stefano Cordone  2 , Matteo Ghione  2 , Daniele Errigo  2 , Pietro Bellone  2
Affiliations

A reliable fossa ovalis impedance mapping for safer transseptal puncture: A new vision beyond voltage

Francesco Pentimalli et al. J Cardiovasc Electrophysiol. 2021 Dec.

Abstract

Introduction: Transseptal puncture (TSP) is widely used in clinical practice but is negatively affected by a nonneglectable rate of complications and X-ray exposure. To address these problems, we investigated whether or not impedance mapping could correctly identify fossa ovalis (FO) and safely guide TSP.

Methods and results: Electroanatomic mapping was performed with CARTO 3 system version 7 and a ThermoCool® SmartTouch® mapping catheter was employed. In each patient, an impedance map and a bipolar voltage map of the whole interatrial septum were collected, acquiring at least 150 points with a contact force ≥2 g and using the pattern matching filter. Thirty-five patients were enrolled. A low impedance area was clearly identified in 34 of them. In 30 patients (88%), the FO was located in the low impedance area. The map was obtained in sinus rhythm in 17 cases (50%); in 15 of these (88%), the TSP site, the patent foramen ovale, or the FO tenting area fell inside the low impedance area. The same numbers were observed when mapping during atrial fibrillation.

Conclusion: To the best of our knowledge, this is the first study that provides the reliability and reproducibility of impedance mapping in identifying FO, an affordable and feasible tool that could be potentially introduced into clinical practice.

Keywords: atrial fibrillation; catheter ablation; electroanatomic mapping; fossa ovalis; impedance; transseptal puncture; zero fluoroscopy.

PubMed Disclaimer

References

REFERENCES

    1. Ross J, Braunwald E, Morrow AG. Transseptal left atrial puncture; new technique for the measurement of left atrial pressure in man. Am J Cardiol. 1959;3:653-655.
    1. Limacher MC, Douglas PS, Germano G, et al. ACC expert consensus document. Radiation safety in the practice of cardiology. American College of Cardiology. J Am Coll Cardiol. 1998;31:892-913.
    1. Enriquez A, Saenz LC, Rosso R, et al. Use of intracardiac echocardiography in interventional cardiology working with the anatomy rather than fighting it. Circulation. 2018;137:2278-2294.
    1. Yu R, Liu N, Lu J, et al. 3-Dimensional transseptal puncture based on electrographic characteristics of fossa ovalis: a fluoroscopy-free and echocardiography-free method. JACC Cardiovasc Interv. 2020;13:1223-1232.
    1. Raju H, Whitaker J, Taylor C, Wright M. Electroanatomic mapping and transoesophageal echocardiography for near zero fluoroscopy during complex left atrial ablation. Hear Lung Circ. 2016;25:652-660.

LinkOut - more resources