Dataset: Development of transseptal puncture in horses EVJ

Background: Radiofrequency ablation has been successfully applied to treat right atrial arrhythmias in horses. Ablation of left-sided arrhythmias requires a retrograde transarterial approach which is complicated. In human medicine, the left atrium is accessed through transseptal puncture (TSP) of the fossa ovalis (FO) using a caudal approach via the femoral vein.Objectives: To develop a zero fluoroscopy TSP technique for horses using a jugular vein (cranial) and transhepatic (caudal) approach.Study design: In vivo experimental study.Methods: Transseptal puncture was performed in 18 horses admitted for euthanasia and donated for scientific research under general anaesthesia: using a jugular vein approach (ten horses), a transhepatic approach (two horses) or both (six horses). Radiofrequency energy was applied on a guidewire to perforate the FO and allow sheath advancement under intracardiac and transthoracic echocardiographic guidance. Puncture lesions were inspected post-mortem.Results: Transseptal puncture was successful in 17/18 horses, of which 15/16 jugular vein approaches and 5/8 transhepatic approaches. Failure was due to technical malfunction, inability to advance the guidewire towards the heart and inability to advance the sheath through the FO. Intracardiac echocardiography was essential to safely guide the puncture process. Atrial arrhythmias caused by the TSP occurred in 13/18 horses. Puncture lesions were found in the right atrium in the FO region, and in the left atrium ventral to pulmonary vein ostium III.Main limitations: As in several horses two approaches were tested consecutively, it cannot be excluded that the second TSP was performed at the previous puncture site. Due to the developmental nature of the study the approaches were not randomized and did not allow comparison.Conclusion: Transseptal puncture is feasible in horses using ultrasound guidance and allows for electrophysiological exploration of the left heart. Further studies are needed to evaluate post-operative follow-up.本研究背景：射频消融（Radiofrequency ablation）已成功应用于治疗马的右房心律失常。针对左侧心律失常的消融需采用逆行经动脉入路，该操作较为复杂。在人类医学中，临床常经股静脉尾侧入路，通过卵圆窝（fossa ovalis, FO）行经房间隔穿刺（transseptal puncture, TSP）以进入左心房。 研究目标：开发一种采用颈静脉（颅侧）及经肝（尾侧）入路的零透视经房间隔穿刺技术，应用于马匹诊疗。 研究设计：体内实验研究。 方法：选取18匹接受安乐死并捐赠用于科研的马匹，在全身麻醉下实施经房间隔穿刺：其中10匹采用颈静脉入路，2匹采用经肝入路，6匹同时采用两种入路。通过在导丝上施加射频能量以穿刺卵圆窝，并在心内超声（intracardiac echocardiography）及经胸超声心动图（transthoracic echocardiography）引导下推进鞘管。术后对穿刺损伤部位进行尸检观察。 结果：18匹马匹中17匹成功完成经房间隔穿刺，其中采用颈静脉入路的16匹中有15匹成功，采用经肝入路的8匹中有5匹成功。穿刺失败原因包括设备技术故障、导丝无法向心脏推进、鞘管无法通过卵圆窝。心内超声是安全引导穿刺过程的必要手段。18匹马匹中有13匹出现经房间隔穿刺诱发的房性心律失常。尸检发现穿刺损伤位于右心房卵圆窝区域，以及左心房肺静脉口Ⅲ腹侧。 主要局限性：由于部分马匹先后接受了两种入路的穿刺操作，无法排除第二次穿刺是在首次穿刺位点进行的可能。鉴于本研究属于探索性阶段，入路方案未进行随机化分组，无法开展入路间的疗效对比。 结论：采用超声引导的经房间隔穿刺技术在马匹中具备可行性，可实现左心系统的电生理探查。未来仍需开展进一步研究以评估术后随访效果。