Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Aug 26, 2015; 7(8): 499-503
Published online Aug 26, 2015. doi: 10.4330/wjc.v7.i8.499
Difficult case of a trans-septal puncture: Use of a “SafeSept” guidewire
Martina Zucchetti, Michela Casella, Antonio Dello Russo, Gaetano Fassini, Corrado Carbucicchio, Eleonora Russo, Vittoria Marino, Valentina Catto, Claudio Tondo
Martina Zucchetti, Michela Casella, Antonio Dello Russo, Gaetano Fassini, Corrado Carbucicchio, Eleonora Russo, Vittoria Marino, Valentina Catto, Claudio Tondo, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy
Author contributions: All authors contributed to the writing and editing of this manuscript.
Institutional review board statement: The study was reviewed and approved by the Centro Cardiologico Monzino IRCCS Institutional Review Board.
Informed consent statement: The patient provided informed written consent prior to ablation procedure.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Martina Zucchetti, MD, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, Via Parea 4, 20138 Milan, Italy. martina.zucchetti@ccfm.it
Telephone: +39-2-58002721 Fax: +39-2-58002782
Received: December 9, 2014
Peer-review started: December 10, 2014
First decision: January 8, 2015
Revised: May 26, 2015
Accepted: June 9, 2015
Article in press: June 11, 2015
Published online: August 26, 2015
Processing time: 260 Days and 14.5 Hours
Abstract

A 69-year-old man was admitted to our center to undergo catheter ablation of paroxysmal atrial fibrillation refractory to antiarrhythmic drug therapy. This procedure required access to the left atrium through the interatrial septum. During hospitalization, the patient performed routinely pre-procedure transthoracic echocardiography and gadolinium-enhanced cardiac magnetic resonance showing a normal anatomy of both the fossa ovalis and the interatrial septum. Access to the left atrium proved difficult and several unsuccessful attempts to perform the trans-septal puncture were made under both fluoroscopy and intracardiac echocardiography guidance, even with radiofrequency energy delivery. Finally, trans-septal puncture was successfully carried out using a novel nitinol J-shaped “SafeSept” trans-septal guidewire, designed to cross the interatrial septum through the trans-septal needle thanks to a special sharp tip. Moreover, thanks to its rounded J shape that reduces the risk of atrial perforation, the “SafeSept” guidewire, when advanced into the left atrium, becomes atraumatic.

Keywords: Trans-septal puncture; “SafeSept” guidewire; Atrial fibrillation; Interatrial septum; Intracardiac echocardiography

Core tip: In recent years, the number of percutaneous therapeutic techniques requiring trans-septal catheterization has increased. We present the case of a 69-year-old man with a ten-year history of paroxysmal atrial fibrillation. Access to the left atrium proved difficult and several unsuccessful attempts to perform the trans-septal puncture were made under both fluoroscopy and intracardiac echocardiography guidance, even with radiofrequency energy delivery. Finally, trans-septal puncture was successfully performed using a novel nitinol “SafeSept” trans-septal guidewire. If the interatrial septum is thickened, scarred, fibrous, too mobile and/or aneurismal, the use of the “SafeSept” guidewire may be a safe and effective option.