Incidence and characteristics of transient St-segment elevation during transseptal puncture.

PURPOSE: Delineate retrospectively and prospectively the incidence and characteristics of transient ST-segment elevation during transseptal puncture. METHODS: The study retrospectively evaluated 307 patients from January 1, 2015, to December 31, 2017, and prospectively evaluated 231 patients from January 1, 2018, to July 31, 2019. RESULTS: The presence of ST-segment elevation was significantly higher in the prospective sample than in the retrospective sample (5.2% vs. 1.3%, p < 0.05). Between the two groups, there was no significant difference in age, sex, comorbidities, left atrial volume index, and the etiology of atrial fibrillation among patients with ST-segment alteration. In all patients, the ST-segment elevation was observed in the inferior wall derivations, except for one patient with ST elevation in lead I, AVL, V1-V4 during the septal puncture, associated with sinus bradycardia and reversed hypotension with intravenous fluids. Comparative analysis of the systolic and diastolic arterial pressure and the minimum heart rate during the phenomenon demonstrated more severity in the retrospectively evaluated population than in the prospective population. There was a significant association between the occurrence of ST-segment elevation > 2 mm and the presence of symptoms. In these patients, coronary angiography showed no alterations. Atropine was administered to one patient who presented with junctional bradycardia after the puncture. This medication reversed the situation. CONCLUSION: ST-segment elevation is a short-term phenomenon that can occur during transseptal catheterization without clinically evident symptoms. The catheter ablation procedure can be safely concluded despite the occurrence of the phenomenon.

Transatrial management of inadvertent puncture of the posterior wall during transseptal access for atrial fibrillation ablation: technical report.

Transseptal puncture for atrial fibrillation ablation is a safe and common procedure. However, complications, such as cardiac tamponade, may be fatal if not recognized and treated. Our goal is to report a bailout strategy, by which management of an inadvertent puncture of the posterior wall of the left atrium was possible. It was followed by successful pulmonary vein isolation, without the need for subsequent subxiphoid puncture.

Presence of a Septal Occluder Is No Longer an Obstacle for Pulmonary Vein Isolation by Cryoablation.

Cryoablation for pulmonary vein isolation in atrial fibrillation has been considered a relative contraindication in the presence of a septal occluder device. We describe the successful conduct of this technique with a multimodality imaging approach.