Transseptal punctures

CARDIAC ELECTROPHYSIOLOGY

Cardiac Arrhythmia

A cardiac arrhythmia is defined as an abnormal heartbeat which happens when the patient’s heart beats too fast, too slow, or in other irregular patterns. There are various types of arrhythmias including tachycardia, bradycardia, atrial flutter, and atrial fibrillation. An arrhythmia can occur without any symptoms however it is typically associated with heart palpitations, chest pains, fainting, or heart failure.

Here are some more detailed descriptions:

Tachycardia – When the heart beats too fast for no corresponding reason, this is referred to as tachycardia. While it is normal for a heart rate to increase under certain circumstances such as aerobic exercise, patients suffering from tachycardia may see their heart rate increase for no apparent reason.

Bradycardia - When the heart beats too slowly this is referred to as bradycardia. It is important that the heart beat at a rate sufficiently high enough to ensure that blood is properly and regularly pumped throughout the body.

Atrial flutter - Under normal conditions, each beat in the upper chambers of the heart is followed by a beat in the lower chambers.  Atrial flutter is the condition where there are more beats in an upper chamber of the heart than in a lower chamber of the heart.

Atrial Fibrillation - Atrial Fibrillation is often referred to as AF or A-Fib and is the most common type of cardiac arrhythmia. Atrial Fibrillation occurs when the heart beats in an irregular manner caused by disorganized electrical signals normally originating in the left upper chamber of the heart.


Treatment of Cardiac Arrhythmias

There are a number of options for treating cardiac arrhythmias that depend on the type and severity of the arrhythmia.

The options for treatment include medication, pacemaker implants, open heart surgery, and interventional catheter based procedures.

These interventional catheter based procedures involve a technique called ‘cardiac ablation’. In such procedures, a catheter is usually advanced from the groin area into the heart. Once in place, energy is delivered through the catheter to a specific location with the goal of re-establishing proper heart conduction. These cardiac ablation procedures are performed by cardiology specialists known as cardiac electrophysiologists. In some cases, the cardiac electrophysiologist has to access the left side of the heart to deal with arrhythmias that originate in the left atrium or left ventricle.

To gain access to the left side of the heart, a transseptal puncture is required. Once the transseptal puncture is done, electrophysiology catheters can be advanced into the left atrium to treat the arrhythmia.


NRG®  Transseptal Needle

The NRG® RF Transseptal Needle is uniquely designed to assist the physician in gaining access to the left atrium. The NRG® needle uses radio frequency (RF) energy in a safe and controlled manner. This allows the physician to advance across the septum in a precise manner without using excessive force. As well, since the tip of the NRG® needle is not sharp, it does not scrape off plastic particles from the inside of the delivery catheter when it is advanced. The use of the NRG® needle is also particularly beneficial for patients that have had prior procedures, which often results in a thickened or scarred septa.  Finally, the NRG® needle adds a level of control to the physician when treating patients that have a naturally floppy or elastic septum that is challenging to cross with a mechanical needle.


INTERVENTIONAL CARDIOLOGY

Valve Repair

The mitral valve controls the flow of blood from the left upper chamber (left atrium) of the heart to the left lower chamber of the heart (left ventricle). In some people, the mitral valve may become damaged and require repair. There are various minimally invasive treatments that can be done on the mitral valve. However, to gain access to the left side of the heart a specialized needle is used to puncture the atrial septum, which is the wall of tissue that separates the left side of the heart from the right. This procedure to access the left side of the heart is called a ‘transseptal puncture’. Through the opening made by the transseptal puncture, the appropriate tools can be advance.

More info at the Cleveland Clinic