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. 2022 Feb 4;38(2):238-244.
doi: 10.1002/joa3.12679. eCollection 2022 Apr.

Transesophageal echocardiography guided transseptal puncture and nadir temperatures in cryoballoon pulmonary vein isolation

Christian Blockhaus  1   2 , Hans-Peter Waibler  1 , Jan-Erik Guelker  2   3 , Heinrich Klues  1 , Alexander Bufe  1   2 , Melchior Seyfarth  2   4 , Buelent Koektuerk  1   2 , Dong-In Shin  1   2
Affiliations

Transesophageal echocardiography guided transseptal puncture and nadir temperatures in cryoballoon pulmonary vein isolation

Christian Blockhaus et al. J Arrhythm. .

Abstract

Introduction: Cryoballoon (CB) guided pulmonary vein isolation (PVI) is an established procedure in the treatment of atrial fibrillation (AF). Transseptal access is an indispensable step during PVI and may be associated with severe complications. For specific interventions, specific puncture sites of the fossa ovalis are advantageous. Here, we analyzed the potential impact of a transesophageal echocardiography (TOE) guided transseptal puncture on nadir temperatures in CB PVI.

Methods and results: We retrospectively analyzed 209 patients undergoing CB PVI in our hospital. The use of TOE had been at the operator's discretion. No TOE-related complications such as perforation of the pharynx or esophagus or loss of teeth were noted. Concerning the applied freezes, we found significantly lower nadir temperatures in all PVs in the TOE group than in the non-TOE group. Procedure time and fluoroscopy time and complications were similar in both groups.

Conclusion: TOE-guided TSP in CB PVI is safe and feasible. Our study found significantly lower nadir temperatures of CB freezes after TOE-guided TSP which potentially underscores the value of a more infero-anterior puncture site.

Keywords: atrial fibrillation; cryoballoon; fossa ovalis; pulmonary vein isolation; transseptal puncture.

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Conflict of interest statement

None for all authors.

Figures

FIGURE 1
FIGURE 1
Fossa ovalis (FO) with recommended puncture site for radiofrequency pulmonary vein isolation (PVI) (yellow), cryoballoon PVI (green), left atrial appendage occluder (blue) and mitral valve intervention (red), adopted from
FIGURE 2
FIGURE 2
Illustration of (A) medial transseptal access and (B) infero‐anterior transseptal access with scheme of a cryoballoon, targeting the right inferior pulmonary vein (view from the left atrium
See this image and copyright information in PMC

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