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Difficult case of a trans-septal puncture: Use of a "SafeSept" guidewire
Martina Zucchetti1, Michela Casella1, Antonio DelloRusso1
1Martina Zucchetti, Michela Casella, Antonio Dello Russo, Gaetano Fassini, Corrado Carbucicchio, Eleonora Russo, Vittoria Marino, Valentina Catto, Claudio Tondo, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy.
Insights
A novel guidewire facilitated trans-septal puncture for atrial fibrillation ablation when other methods failed. This new device improved procedural success and patient safety during cardiac interventions.
Area of Science:
- Cardiovascular Medicine
- Medical Devices
- Interventional Cardiology
Background:
- Catheter ablation for paroxysmal atrial fibrillation requires trans-septal puncture to access the left atrium.
- Standard trans-septal access methods can be challenging, especially with normal septal anatomy.
- Previous attempts using fluoroscopy, intracardiac echocardiography, and radiofrequency energy were unsuccessful in this case.
Observation:
- A 69-year-old male patient undergoing ablation for drug-refractory atrial fibrillation experienced difficulties with trans-septal access.
- Pre-procedure imaging confirmed normal anatomy of the fossa ovalis and interatrial septum.
- Multiple attempts at trans-septal puncture failed.
Findings:
- A novel nitinol J-shaped "SafeSept" trans-septal guidewire was successfully used to achieve left atrial access.
- The guidewire features a sharp tip for crossing the septum and a J-shape to minimize perforation risk.
- The guidewire became atraumatic once advanced into the left atrium.
Implications:
- The "SafeSept" guidewire offers a potentially safer and more effective solution for challenging trans-septal punctures.
- This innovation may improve success rates in catheter ablation procedures for atrial fibrillation.
- Advancements in guidewire technology can enhance patient outcomes in complex cardiac interventions.
Abstract:
A 69-year-old man was admitted to our center to undergo catheter ablation of paroxysmal atrial fibrillation refractory to antiarrhythmic drug therapy. This procedure required access to the left atrium through the interatrial septum. During hospitalization, the patient performed routinely pre-procedure transthoracic echocardiography and gadolinium-enhanced cardiac magnetic resonance showing a normal anatomy of both the fossa ovalis and the interatrial septum. Access to the left atrium proved difficult and several unsuccessful attempts to perform the trans-septal puncture were made under both fluoroscopy and intracardiac echocardiography guidance, even with radiofrequency energy delivery. Finally, trans-septal puncture was successfully carried out using a novel nitinol J-shaped "SafeSept" trans-septal guidewire, designed to cross the interatrial septum through the trans-septal needle thanks to a special sharp tip. Moreover, thanks to its rounded J shape that reduces the risk of atrial perforation, the "SafeSept" guidewire, when advanced into the left atrium, becomes atraumatic.
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