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Updated: Dec 20, 2025
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Transbaffle/transconduit puncture using a simple CARTO-guided approach without echocardiography in patients with
Mikael Laredo1, Victor Waldmann2,3, Gilles Soulat4
1Unité de Rythmologie, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne Université, AP-HP, Paris, France.
Insights
This study shows that computed tomography (CT) 3D reconstruction merged with electro-anatomical mapping (EAM) enables safe transbaffle/transconduit puncture for catheter ablation (CA) in complex congenital heart disease (CHD) patients.
Area of Science:
- Cardiology
- Medical Imaging
- Electrophysiology
Background:
- Catheter ablation (CA) for atrial tachyarrhythmias (ATs) in complex congenital heart disease (CHD) patients presents significant technical challenges, particularly for transbaffle or transconduit punctures.
- Traditional methods often rely on intra-procedure echocardiographic guidance, which may not always be optimal.
Purpose of the Study:
- To evaluate the feasibility and safety of performing transbaffle and transconduit punctures for CA in CHD patients.
- To assess a novel technique combining computed tomography (CT) three-dimensional (3D) reconstruction with electro-anatomical mapping (EAM) for guidance, eliminating the need for per-procedure echocardiography.
Main Methods:
- Eighteen CHD patients (12 atrial-switch, 6 Fontan surgery) undergoing CA for ATs requiring antegrade approach with intracardiac puncture were included.
- Cardiac CT with 3D reconstruction was merged with EAM data to precisely guide the ablation catheter to the optimal puncture site.
- Punctures were performed under fluoroscopic guidance, with balloon expansion used for transconduit punctures and in select transbaffle cases.
Main Results:
- The combined CT 3D reconstruction and EAM technique facilitated successful transbaffle/transconduit punctures in all cases.
- Seventeen intra-atrial reentrant tachycardias and 9 focal ATs were successfully ablated without acute complications.
- Median time to pulmonary atrium access was 78.5 minutes, with a median total fluoroscopy time of 23 minutes.
Conclusions:
- Transbaffle and transconduit punctures are feasible and safe in complex CHD patients using a straightforward technique.
- The integration of CT 3D reconstruction with EAM provides effective guidance for these challenging procedures, obviating the need for intra-procedure echocardiography.
Introduction:
Catheter ablation (CA) of atrial tachyarrhythmias (ATs) in patients with complex congenital heart disease (CHD) often requires technically challenging transbaffle or transconduit puncture. The aim was to assess the feasibility and safety of transbaffle/transconduit puncture based on computed tomography (CT) three-dimensional (3D) reconstruction merged with electro-anatomical mapping (EAM) without per-procedure echocardiographic guidance.
Methods And Results:
We included 18 consecutive CHD patients in two centers who had atrial-switch or Fontan surgery and underwent CA of AT by an antegrade approach requiring intracardiac puncture. Twelve patients with atrial-switch surgery and six patients with extracardiac Fontan surgery were referred for CA of AT. Cardiac CT with 3D reconstruction was performed before the procedure. The 3D volume of the systemic venous atrium or extracardiac conduit acquired by EAM was merged with the corresponding CT 3D reconstruction. The ablation catheter was positioned at the optimal puncture site. Under fluoroscopic guidance, the needle was positioned next to the ablation and the puncture was performed. Balloon expansion of the puncture site was performed in every case of transconduit puncture and in two (17%) cases of transbaffle puncture. Overall, 17 intra-atrial reentrant tachycarrythmias and 9 focal ATs were successfully ablated, with no acute complications. The median time to access the pulmonary atrium was 78.5 minutes (range, 55-185) and total median fluoroscopy time was 23 minutes (range, 7-53).
Conclusions:
Transbaffle and transconduit punctures can be performed safely in CHD patients by using a simple technique relying on CT 3D reconstruction and EAM.
