Learning Process for Transseptal Puncture Guided by Intracardiac Echocardiography

We prospectively analyzed the learning process for transseptal catheterization guided by intracardiac echocardiography, in 50 patients who underwent radiofrequency ablation for left atrial arrhythmias. In 20 patients the intracardiac echocardiography catheter was positioned in the right atrium to visualize the fossa ovalis and the tenting of the fossa caused by the Brockenbrough needle. In the other 30 patients, the intracardiac echocardiography catheter was positioned so that it impinged upon the fossa ovalis, and the needle was advanced alongside the intracardiac echocardiography catheter under fluoroscopic guidance in two orthogonal projections. In all but one patient, transseptal catheterization was performed successfully on the first attempt. The learning process for transseptal puncture guided by intracardiac echocardiography was uncomplicated, resulting in a procedure that is safe and effective. The intervention is simplified by positioning the echocardiography catheter at the fossa ovalis and using this as a reference point for fluoroscopic monitoring of the progress of the Brockenbrough needle.