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Transseptal Puncture Guided by CT-Derived 3D-Augmented Fluoroscopy.

Felix Bourier1, Tilko Reents1, Sonia Ammar-Busch1

  • 1Department of Electrophysiology, German Heart Center Munich, Technische, Universitaet Munich, Germany.

Journal of Cardiovascular Electrophysiology
|December 8, 2015
PubMed
Summary

This study introduces a novel 3D-augmented fluoroscopy technique for transseptal puncture, enhancing safety and accuracy in left atrial access. The method combines 3D mapping with CT-derived anatomy overlays for improved procedural guidance.

Keywords:
3D-mapping systems3D-overlayatrial fibrillation ablationfluoroscopytransseptal puncture

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Area of Science:

  • Cardiovascular Interventions
  • Medical Imaging Technology
  • Electrophysiology

Background:

  • Transseptal puncture for left atrial access traditionally relies on fluoroscopy and echocardiography.
  • Existing methods present limitations in anatomical visualization during the procedure.

Purpose of the Study:

  • To present an easily applicable approach for guiding transseptal puncture using 3D-mapping and CT-derived 3D-overlayed anatomy.
  • To evaluate the feasibility, safety, and accuracy of this novel technique.

Main Methods:

  • A CT-based 3D reconstruction of cardiac anatomy and spine was created for 65 patients.
  • The 3D anatomy was overlaid onto fluoroscopy using a 3D-mapping system (CARTO3 UNIVU).
  • Feasibility, safety, and accuracy (contour offsets) were assessed, along with overlay registration accuracy.

Main Results:

  • Transseptal puncture was successfully performed in all 65 patients without complications.
  • High accuracy was demonstrated with small contour offsets (1.3-1.7 mm) between the 3D overlay and actual anatomy.
  • The average time for anatomy segmentation was ~204 seconds, and overlay registration took ~18 seconds.

Conclusions:

  • Three-dimensional-augmented fluoroscopy is a feasible, safe, and accurate guidance method for transseptal puncture.
  • This technique offers an easily applicable advancement over traditional imaging modalities.
  • The study highlights the potential of integrating advanced imaging for improved cardiac procedures.