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Left main bronchus as a guide for individualized transseptal puncture using a conventional fluoroscopic approach in cryoballoon ablation of atrial fibrillation [Anatol J Cardiol]
Anatol J Cardiol. Ahead of Print: AJC-08566 | DOI: 10.14744/AnatolJCardiol.2018.08566  

Left main bronchus as a guide for individualized transseptal puncture using a conventional fluoroscopic approach in cryoballoon ablation of atrial fibrillation

Yuan Yuan1, Minxia Zhang2, Wangwei Yang1, Ling Tao1, Hexiang Cheng1
1Department Of Cardiology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi’an, China
2Department Of Cardiology, Zhenghe Hospital, Xi’an, China

Objective: Although, imaging modalities such as transesophageal and intracardiac echo (ICE) have helped improve the safety of atrial transseptal puncture (TSP), fluoroscopy is still traditionally and widely used in TSP. The aim of this study is to evaluate an individual knack for TSP during cryoballoon ablation of atrial fibrillation (AF) under fluoroscopy. Methods: Through the prospective study of 72 cases of patients with paroxysmal or persistent AF admitted for cryoablation (CB-2, Arctic Front Advance, Medtronic, Inc.) in our center, 46 cases using puncture site toward bifurcation of left main bronchus (LMB group), 26 cases using an anterior-inferior puncture site (AI group). The acute pulmonary vein isolation (PVI) success rate, single-procedure success rate and time-to-effect (TTE) between the two groups were analyzed. Results: All PVs were identified and successfully isolated, there are no differences in two groups. But, a shorter mean TTE was found in LMB group compared with AI group. Moreover, higher single-procedure success rate was observed in LMB group. Conclusion: The bifurcation of left main bronchus can be clearly evaluated in each patient under fluoroscopy and is anatomical landmark for location of left pulmonary vein. Transseptal puncture guided by LMB is a newly practical method for choosing a individualized transseptal sites for catheter ablation of AF, which can help to shorten TTE and procedure time.

Keywords: Left main bronchus, Transseptal puncture, Cryoballoon ablation, Atrial fibrillation, Fluoroscopy




Corresponding Author: Yuan Yuan, China


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