Sequential multimodality imaging-guided transseptal strategy for cryoballoon ablation in cor triatriatum sinister
Giuseppe Romano1, Vito Bonomo2, Francesco Sabatino2
1Azienda Ospedaliera Ospedali Riuniti Villa Sofia Cervello, U.O.C. Cardiologia, Presidio Cervello, Palermo, Italy. g.romano@villasofia.it.
Abstract:
To describe a sequential multimodality imaging strategy for transseptal access during cryoballoon ablation in a patient with cor triatriatum sinister (CTS).
Methods:
A 55-year-old man with paroxysmal atrial fibrillation and CTS underwent preprocedural cardiac computed tomography (CCT), followed by real-time transesophageal echocardiography (TEE), contrast confirmation, and fluoroscopic guidance during the procedure.
Results:
CCT demonstrated pulmonary vein drainage into a Proximal Chamber (Posterior-Superior), separated from the Distal Chamber (Anterior-Inferior) by a membrane. Real-time TEE identified and confirmed an anterosuperior transseptal site, with septal tenting before needle passage. After a single BRK needle puncture, contrast confirmed access to the pulmonary-vein-containing chamber, allowing advancement of the FlexCath Advance catheter (Medtronic) and cryoballoon isolation of all 4 pulmonary veins without procedural complications.
Conclusion:
In CTS, transseptal access should be tailored to the individual atrial anatomy. Sequential use of CCT, real-time TEE, contrast, and fluoroscopy can provide complementary information at the successive stages of the procedure.
