{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T02:46:11Z","timestamp":1792550771361,"version":"4.5.0"},"reference-count":23,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2019,12,23]],"date-time":"2019-12-23T00:00:00Z","timestamp":1577059200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pacing Clinical Electrophis"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Atrial fibrillation (AF) ablation requires access to the left atrium (LA) via transseptal puncture (TP). TP is traditionally performed with fluoroscopic guidance. Use of intracardiac echocardiography (ICE) and three\u2010dimensional mapping allows for zero fluoroscopy TP.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To demonstrate safety and efficacy of zero fluoroscopy TP using multiple procedural approaches.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients undergoing AF ablation between January 2015 and November 2017 at five institutions were included. ICE and three\u2010dimensional mapping were used for sheath positioning and TP. Variable technical approaches were used across centers including placement of J wire in the superior vena cava with ICE guidance followed by dragging down the transseptal sheath into the interatrial septum, or guiding the transseptal sheath directly to the interatrial septum by localizing the ablation catheter with three\u2010dimensional mapping and replacing it with the transseptal needle once in position. In patients with pacemaker\/implantable cardiac defibrillator leads, pre\u2010\/poststudy device interrogation was performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 747 TPs were performed (646 patients, age 63.1\u00a0\u00b1\u00a013.1, 67.5% male, LA volume index 34.5\u00a0\u00b1\u00a015.8\u00a0mL\/m<jats:sup>2<\/jats:sup>, ejection fraction 57.7\u00a0\u00b1\u00a010.9%) with 100% success. No punctures required fluoroscopy. Two pericardial effusions, two pericardial tamponades requiring pericardiocentesis, and one transient ischemic attack were observed during the overall ablation procedure, with a total complication rate of 0.7%. There were no other periprocedural complications related to TP, including intrathoracic bleeding, stroke, or death both immediately following TP and within 30 days of the procedure. In patients with intracardiac devices, no device\u2010related complications were observed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>TP can be safely and effectively performed without the need for fluoroscopy.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pace.13841","type":"journal-article","created":{"date-parts":[[2019,11,18]],"date-time":"2019-11-18T06:58:59Z","timestamp":1574060339000},"page":"12-18","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":55,"title":["Safety and efficacy of zero fluoroscopy transseptal puncture with different approaches"],"prefix":"10.1111","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0476-2972","authenticated-orcid":false,"given":"Tina","family":"Baykaner","sequence":"first","affiliation":[{"name":"Department of Medicine Stanford University  Stanford California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth K.","family":"Quadros","sequence":"additional","affiliation":[{"name":"Department of Medicine Brigham and Women's Hospital  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amit","family":"Thosani","sequence":"additional","affiliation":[{"name":"Cardiovascular Institute Allegheny Health Network  Pittsburgh Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Babak","family":"Yasmeh","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Cincinnati  Cincinnati Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raman","family":"Mitra","sequence":"additional","affiliation":[{"name":"Department of Medicine Beacon Health System  South Bend Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emerson","family":"Liu","sequence":"additional","affiliation":[{"name":"Cardiovascular Institute Allegheny Health Network  Pittsburgh 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Brigham and Women's Hospital  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,12,23]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2017.05.012"},{"key":"e_1_2_7_3_1","first-page":"e210","article-title":"AHA\/ACC\/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: executive summary","volume":"138","author":"Al\u2010Khatib 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