Modified intracardiac echocardiography (ICE)-guided transseptal puncture under ablation catheter guidance

Zero-fluoroscopy procedures have become increasingly popular in electrophysiological interventional surgery. As a core technology for achieving zero-fluoroscopy, traditional transseptal puncture (TSP) under intracardiac echocardiography (ICE) guidance has several limitations that hinder its widespread application and further development. This study aims to introduce and evaluate the efficacy and safety of a modified TSP technique developed based on clinical practice, which has the potential to overcome the shortcomings of traditional ICE-guided TSP.

A total of 77 patients who underwent radiofrequency ablation for atrial fibrillation (AF) between March 1, 2022 and February 28, 2023 were enrolled. Among them, 44 patients underwent traditional ICE-guided TSP, and 33 patients underwent modified ICE-guided TSP. The success rate, numbers of puncture attempts, puncture duration, proportion of ideal puncture location and incidence of puncture-related complications were recorded.

There were no significant differences in baseline characteristics between the two groups. Compared with the traditional group, the modified group had a significantly lower number of puncture attempts (1.25 ± 0.44 vs.1.06 ± 0.24, p = 0.018) and shorter puncture duration (2.52 ± 0.83 vs.3.94 ± 2.15 min, p = 0.001). No significant differences were observed in TSP success rate, proportion of ideal puncture location or incidence of puncture-related complications between the two groups.

This study presents a modified ICE-guided TSP technique using an ablation catheter for guidance. This technique simplifies the operation of the puncture component and eliminates the need for ICE view tracking. It offers advantages including high success rate, favorable safety profile, simple procedural steps, ease of use, and a short learning curve, making it worthy of clinical promotion and application.