Study on the Curative Effect and Safety of Radiofrequency Catheter Ablation of Paroxysmal Atrial Fibrillation via Zero-Fluoroscopy Transseptal Puncture under the Dual Guidance of Electroanatomical Mapping and Intracardiac Echocardiography

Figure 1

Transseptal puncture with fluoroscopy. (a) At the right anterior oblique (RAO) angle of 30°, a 10-polar diagnostic catheter was placed in the coronary sinus. (b) At the anterior posterior (AP) position, the long sheath was sent into the superior vena cava (SVC) through the guidewire. Then, we removed the guidewire and sent a transseptal needle into the long sheath. The distance between the tip of the long sheath and the tip of transseptal needle was about 1 cm. (c, d) Upon withdrawal of the long sheath and the transseptal needle together, the tip of the sheath was observed to jump twice. After jumping for the second time, the tip was pointing toward to the foramen ovale. (e) RAO 45° was used to confirm that the tip of the sheath was vertical to the atrial septum. (f) A transseptal needle was used to puncture the atrial septum. (g) Contrast medium was injected into LA through the needle, and a dark thick line was shown under fluoroscopy at the AP position. (h, i) We pushed dilator inside the long sheath through the transseptal needle into the LA. Then, the needle was withdrawn, and the long wire was placed in the left superior pulmonary vein.

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