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Home / Equine Research Bank / Equine Vet J / Development of an atrial transseptal puncture procedure in h...
Equine veterinary journal2024; 57(1); 243-255; doi: 10.1111/evj.14084

Development of an atrial transseptal puncture procedure in horses to access the left heart: An ultrasound-guided jugular vein and transhepatic approach.

Abstract: 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. Objective: To develop a zero fluoroscopy TSP technique for horses using a jugular vein (cranial) and transhepatic (caudal) approach. Methods: 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 (10 horses), a transhepatic approach (2 horses) or both (6 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 toward 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 left atrium ventral to pulmonary vein ostium III. Conclusions: Because 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 randomised and did not allow comparison. Conclusions: 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.
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Publication Date: 2024-03-24 PubMed ID: 38522423DOI: 10.1111/evj.14084Google Scholar: Lookup
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Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

This research conducted an experimental study to develop a method for performing a left-sided heart access procedure, known as a transseptal puncture, in horses. The study successfully established a technique using ultrasound guidance with both a cranial (jugular vein) approach and caudal (transhepatic) approach.

Methodology

  • The study was conducted on 18 horses that were under general anesthesia. These horses were admitted for euthanasia and donated for scientific research.
  • The research team experimented with two methods of accessing the left atrium of the horse’s heart – via the jugular vein (10 horses) and a transhepatic approach (2 horses), and in some cases, they used both approaches (6 horses).
  • To perforate the fossa ovalis (FO) and allow access to the left atrium, radiofrequency energy was applied on a guidewire, guided by both intracardiac and transthoracic echocardiographic imaging.
  • Post-euthanasia, puncture lesions were examined for further investigation.

Results

  • Transseptal puncture was successful in 17 out of 18 horses. In terms of the methods employed, 15 out of 16 attempts using the jugular vein approach met with success, and in the case of the transhepatic approach, 5 out of 8 attempts were successful.
  • The reasons for failure were mainly due to technical issues, like the inability to advance the guidewire toward the heart or failure to navigate the sheath through the FO.
  • Intracardiac echocardiography proved critical in the safe and accurate execution of the transseptal puncture process.
  • It was observed that the TSP procedure induced atrial arrhythmias in 13 out of 18 horses. Post-mortem examinations revealed puncture lesions in the right atrium in the FO region, and in the left atrium ventral to the third pulmonary vein ostium.

Conclusions

  • The study highlighted a possibility of correlation between the two approaches, as in a few horses, both techniques were performed sequentially – this could lead to the second TSP being performed at the first puncture site. The researchers indicate that due to the developmental nature of the study, approaches were not randomised and thus a direct comparison could not be made.
  • Overall, the research demonstrated the feasibility of performing a transseptal puncture in horses using ultrasound guidance for access to the left heart. However, the researchers recommend further studies for evaluating the post-operative conditions and outcomes.

Cite This Article

APA
Vernemmen I, Van Steenkiste G, Buschmann E, Cornelis K, Schauvliege S, Ibrahim L, Decloedt A, van Loon G. (2024). Development of an atrial transseptal puncture procedure in horses to access the left heart: An ultrasound-guided jugular vein and transhepatic approach. Equine Vet J, 57(1), 243-255. https://doi.org/10.1111/evj.14084

Publication

Equine veterinary journal
ISSN: 2042-3306
NlmUniqueID: 0173320
Country: United States
Language: English
Volume: 57
Issue: 1
Pages: 243-255

Researcher Affiliations

Vernemmen, Ingrid
  • Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium.
Van Steenkiste, Glenn
  • Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium.
Buschmann, Eva
  • Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium.
Cornelis, Kristoff
  • Cardiology Department, Maria Middelares Heart Centre, Ghent, Belgium.
Schauvliege, Stijn
  • Department of Surgery and Anaesthesiology of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium.
Ibrahim, Lara
  • Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium.
Decloedt, Annelies
  • Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium.
van Loon, Gunther
  • Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium.

MeSH Terms

  • Animals
  • Horses
  • Jugular Veins / surgery
  • Punctures / veterinary
  • Punctures / methods
  • Heart Atria / surgery
  • Female
  • Male
  • Horse Diseases / surgery

Grant Funding

  • 1S71521N / Fonds Wetenschappelijk Onderzoek
  • 1SE9122N / Fonds Wetenschappelijk Onderzoek
  • 01B05818 / Bijzonder Onderzoeksfonds UGent

References

This article includes 52 references
  1. Slack J, Boston RC, Soma LR, Reef VB. Occurrence of cardiac arrhythmias in standardbred racehorses. Equine Vet J 2015;47:398–404.
    doi: 10.1111/evj.12299google scholar: lookup
  2. Nath LC, Elliott AD, Weir J, Curl P, Rosanowski SM, Franklin S. Incidence, recurrence, and outcome of postrace atrial fibrillation in thoroughbred horses. J Vet Intern Med 2021;35:1111–1120.
    doi: 10.1111/jvim.16063google scholar: lookup
  3. Barbesgaard L, Buhl R, Meldgaard C. Prevalence of exercise‐associated arrhythmias in normal performing dressage horses. Equine Vet J 2010;42(S38):202–207.
    doi: 10.1111/j.2042-3306.2010.00223.xgoogle scholar: lookup
  4. Marr CM, Franklin S, Garrod G, Wylie C, Smith L, Dukes‐McEwan J. Exercise‐associated rhythm disturbances in poorly performing thoroughbreds: risk factors and association with racing performance. Equine Vet J 2021;53:656–669.
    doi: 10.1111/evj.13354google scholar: lookup
  5. Jose‐Cunilleras E, Young LE, Newton JR, Marlin DJ. Cardiac arrhythmias during and after treadmill exercise in poorly performing thoroughbred racehorses. Equine Vet J 2006;38:163–170.
    doi: 10.1111/j.2042-3306.2006.tb05534.xgoogle scholar: lookup
  6. Durando MM, Slack J, Birks E, Belcher C, Kohn C. Premature depolarisations in horses competing in United States Eventing Association and Federation Equestre Internationale‐sanctioned 3‐day events. Equine Vet J 2023;56(1):59–68.
    doi: 10.1111/evj.13948google scholar: lookup
  7. Brugada J, Katritsis DG, Arbelo E, Arribas F, Bax JJ, Blomstrom‐Lundqvist C. 2019 ESC guidelines for the management of patients with supraventricular tachycardia the task force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC). Eur Heart J 2020;41(5):655–720.
    doi: 10.1093/eurheartj/ehz467google scholar: lookup
  8. Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomstrom‐Lundqvist C. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio‐Thoracic Surgery (EACTS): the task force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the european heart rhythm association (EHRA) of the ESC. Eur Heart J 2021;42:373–498.
    doi: 10.1093/eurheartj/ehaa612google scholar: lookup
  9. Schwarzwald CC, Hamlin RL, Bonagura JD, Nishijima Y, Meadows C, Carnes CA. Atrial, SA nodal and AV nodal electrophysiology in standing horses: Normal findings and electrophysiologic effects of quinidine and diltiazem. J Cardiovasc Electrophysiol 2007;21:166–175.
    doi: 10.1892/0891-6640(2007)21[166:asnaan]2.0.co;2google scholar: lookup
  10. De Clercq D, Broux B, Vera L, Decloedt A, van Loon G. Measurement variability of right atrial and ventricular monophasic action potential and refractory period measurements in the standing non‐sedated horse. BMC Vet Res 2018;14:101.
    doi: 10.1186/s12917-018-1399-ygoogle scholar: lookup
  11. Carstensen H, Nissen SD, Saljic A, Hesselkilde EM, van Hunnik A, Hohl M. Long‐term training increases atrial fibrillation sustainability in standardbred racehorses. J Cardiovasc Transl Res 2023;16(5):1205–1219.
    doi: 10.1007/s12265-023-10378-6google scholar: lookup
  12. De Clercq D, Decloedt A, Sys SU, Verheyen T, Van Der Vekens N, van Loon G. Atrial fibrillation cycle length and atrial size in horses with and without recurrence of atrial fibrillation after electrical cardioversion. J Vet Intern Med 2014;28:624–629.
    doi: 10.1111/jvim.12322google scholar: lookup
  13. De Clercq D, Decloedt A, Tavernier R, Deprez P, van Loon G. Atrial and ventricular electrical and contractile remodelling and reverse remodelling due to chronic pacing‐induced atrial fibrillation in horses: preliminary results. Vlaams Diergeneeskd Tijdschr 2019;88:269–277.
  14. Broux B, De Clercq D, Decloedt A, Vera L, Devreese M, Gehring R. Pharmacokinetics and electrophysiological effects of sotalol hydrochloride in horses. Equine Vet J 2018;50(3):377–383.
    doi: 10.1111/evj.12765google scholar: lookup
  15. De Clercq D, van Loon G, Baert K, Tavernier R, Croubels S, De Backer P. Intravenous amiodarone treatment in horses with chronic atrial fibrillation. Vet J 2006;172(1):129–134.
    doi: 10.1016/j.tvjl.2005.04.001google scholar: lookup
  16. Hesselkilde E, Linz D, Saljic A, Carstensen H, Kutieleh R, Jespersen T. First catheter‐based high‐density endocardial 3d electroanatomical mapping of the right atrium in standing horses. Equine Vet J 2021;53(1):186–193.
    doi: 10.1111/evj.13265google scholar: lookup
  17. Van Steenkiste G, De Clercq D, Boussy T, Vera L, Schauvliege S, Decloedt A. Three dimensional ultra‐high‐density electro‐anatomical cardiac mapping in horses: methodology. Equine Vet J 2020;52(5):765–772.
    doi: 10.1111/evj.13229google scholar: lookup
  18. Van Steenkiste GLV, Decloedt A, Schauvliege S, Boussy T, van Loon G. Endocardial electro‐anatomic mapping in healthy horses: Normal sinus impulse propagation in the left and right atrium and the ventricles. Vet J 2020;258:105452.
    doi: 10.1016/j.tvjl.2020.105452google scholar: lookup
  19. Van Steenkiste G, Boussy T, Duytschaever M, Vernemmen I, Schauvlieghe S, Decloedt A. Detection of the origin of atrial tachycardia by 3D electro‐anatomical mapping and treatment by radiofrequency catheter ablation in horses. J Vet Intern Med 2022;36(4):1481–1490.
    doi: 10.1111/jvim.16473google scholar: lookup
  20. Buschmann E, Van Steenkiste G, Boussy T, Vernemmen I, Schauvliege S, Decloedt A. Three‐dimensional electro‐anatomical mapping and radiofrequency ablation as a novel treatment for atrioventricular accessory pathway in a horse: a case report. J Vet Intern Med 2023;37(2):728–734.
    doi: 10.1111/jvim.16668google scholar: lookup
  21. Linz D, Hesselkilde E, Kutieleh R, Jespersen T, Buhl R, Sanders P. Pulmonary vein firing initiating atrial fibrillation in the horse: oversized dimensions but similar mechanisms. J Cardiovasc Electrophysiol 2020;31:1211–1212.
    doi: 10.1111/jce.14422google scholar: lookup
  22. Young LE, Blissit KJ, Clutton RE, Molony V, Darke PGG. Feasibility of transoesophageal echocardiography for evaluation of left ventricular performance in anaesthetised horses. Equine Vet J 1995;27:63–70.
    doi: 10.1111/j.2042-3306.1995.tb04991.xgoogle scholar: lookup
  23. Brown CM, Holmes JR. Haemodynamics in the horse: 1. Pressure pulse contours. Equine Vet J 1978;10:188–194.
    doi: 10.1111/j.2042-3306.1978.tb02257.xgoogle scholar: lookup
  24. Manohar M, Goetz TE, Hutchens E, Coney E. Atrial and ventricular myocardial blood flows in horses at rest and during exercise. Am J Vet Res 1994;55:1464–1469.
  25. Dencker D, Pedersen F, Engstrøm T, Køber L, Højberg S, Nielsen MB. Major femoral vascular access complications after coronary diagnostic and interventional procedures: a Danish register study. Int J Cardiol 2016;202:604–608.
    doi: 10.1016/j.ijcard.2015.09.018google scholar: lookup
  26. Khan M, Schmidt DH, Bajwa T, Shalev Y. Coronary air embolism: incidence, severity, and suggested approaches to treatment – comment. Cathet Cardiovasc Diagn 1995;36:313–318.
    doi: 10.1002/ccd.1810360406google scholar: lookup
  27. Earley MJ. How to perform a transseptal puncture. Heart 2009;95:85–92.
    doi: 10.1136/hrt.2007.135939google scholar: lookup
  28. Ross J, Braunwald E, Morrow AG. Transseptal left atrial puncture ‐ new technique for the measurement of left atrial pressure in man. Am J Cardiol 1959;3:653–655.
    doi: 10.1016/0002-9149(59)90347-9google scholar: lookup
  29. Alkhouli M, Rihal CS, Holmes DR Jr. Transseptal techniques for emerging structural heart interventions. JACC Cardiovasc Interv 2016;9:2465–2480.
    doi: 10.1016/j.jcin.2016.10.035google scholar: lookup
  30. Al‐Sinan A, Chan KH, Young GD, Martin A, Sepahpour A, Sy RW. Systematic review of electrophysiology procedures in patients with obstruction of the inferior vena cava. J Cardiovasc Electrophysiol 2022;33:1300–1311.
    doi: 10.1111/jce.15505google scholar: lookup
  31. Singh SM, Neuzil P, Skoka J, Kriz R, Popelova J, Love BA. Percutaneous transhepatic venous access for catheter ablation procedures in patients with interruption of the inferior vena cava. Circ Arrhythm Electrophysiol 2011;4(2):235–241.
    doi: 10.1161/circep.110.960856google scholar: lookup
  32. Ebeid MR. Transhepatic vascular access for diagnostic and interventional procedures: techniques, outcome, and complications. Catheter Cardiovasc Interv 2007;69:594–606.
    doi: 10.1002/ccd.21012google scholar: lookup
  33. Pedra CAC, Neves JR, Pedra SRF, Ferreiro CR, Jatene I, Cortez TM. New transcatheter techniques for creation or enlargement of atrial septal defects in infants with complex congenital heart disease. Catheter Cardiovasc Interv 2007;70(5):731–739.
    doi: 10.1002/ccd.21260google scholar: lookup
  34. Vera L, Arias DC, Muylle S, Stergiopulos N, Segers P, van Loon G. A 1D computer model of the arterial circulation in horses: an important resource for studying global interactions between heart and vessels under normal and pathological conditions. PLoS One 2019;14:14.
    doi: 10.1371/journal.pone.0225396google scholar: lookup
  35. van Loon G, Van Steenkiste G, Vera L, Decloedt A. Catheter‐based electrical interventions to study, diagnose and treat arrhythmias in horses: from refractory period to electro‐anatomical mapping. Vet J 2020;263:105519.
    doi: 10.1016/j.tvjl.2020.105519google scholar: lookup
  36. Vernemmen I, Paulussen E, Dauvillier J, Decloedt A, van Loon G. Three‐dimensional and catheter‐based intracardiac echocardiographic characterization of the interatrial septum in 2 horses with suspicion of a patent foramen ovale. J Vet Intern Med 2022;36:1535–1542.
    doi: 10.1111/jvim.16451google scholar: lookup
  37. Barone R. Anatomie comparée des mammifères domestiques: Angiologie. 2nd ed. Paris, France: Editions Vigot; 2001.
  38. Kaplan RM, Wasserlauf J, Knight BP. Transseptal access: a review of contemporary tools. J Cardiovasc Electrophysiol 2022;33:1927–1931.
    doi: 10.1111/jce.15428google scholar: lookup
  39. Vernemmen I, Vera L, Van Steenkiste G, Deserranno B, Muylle S, Decloedt A. Right atrial‐related structures in horses of interest during electrophysiological studies. Equine Vet J 2021;53(6):1210–1217.
    doi: 10.1111/evj.13413google scholar: lookup
  40. Theocharopoulos N, Damilakis J, Perisinakis K, Manios E, Vardas P, Gourtsoyiannis N. Occupational exposure in the electrophysiology laboratory: quantifying and minimizing radiation burden. Br J Radiol 2006;79:644–651.
    doi: 10.1259/bjr/76128583google scholar: lookup
  41. Bartel T, Muller S, Biviano A, Hahn RT. Why is intracardiac echocardiography helpful? Benefits, costs, and how to learn. Eur Heart J 2014;35:69–76.
    doi: 10.1093/eurheartj/eht411google scholar: lookup
  42. Ibrahim L, van Loon G, Cornillie P. Morphological evidence of a potential arrhythmogenic substrate in the caudal right atrium of horses. Equine Vet J 2022;54:16.
    doi: 10.1111/evj.21_13855google scholar: lookup
  43. Elayi CS, Gurley JC, Di Sessa TG, Kakavand B. Surgical electrocautery facilitated transseptal puncture in children. Pacing Clin Electrophysiol 2011;34:827–831.
    doi: 10.1111/j.1540-8159.2011.03056.xgoogle scholar: lookup
  44. Gordon BM, Levi DS, Shannon KM. Electrosurgical energy in combination with a transseptal needle: a novel method for the creation of an atrial communication in hypoplastic left heart syndrome with intact atrial septum. Catheter Cardiovasc Interv 2009;73:113–116.
    doi: 10.1002/ccd.21754google scholar: lookup
  45. Veldtman GR, Hartley A, Visram N, Benson LN. Radiofrequency applications in congenital heart disease. Expert Rev Cardiovasc Ther 2004;2:117–126.
    doi: 10.1586/14779072.2.1.117google scholar: lookup
  46. Ross J, Braunwald E, Morrow AG. Left heart catheterization by the transseptal route ‐ a description of the technic and its applications. Circulation 1960;22:927–934.
    doi: 10.1161/01.cir.22.5.927google scholar: lookup
  47. Brockenbrough EC, Braunwald E, Ross J. Transseptal left heart catheterization ‐ a review of 450 studies and description of an improved technic. Circulation 1962;25:15–21.
    doi: 10.1161/01.cir.25.1.15google scholar: lookup
  48. Allen J, Phipps K, Barrett K. Transseptal puncture in the dog utilizing threedimensional transesophageal echocardiographic guidance. J Vet Cardiol 2024;51:64–71.
    doi: 10.1016/j.jvc.2023.11.012google scholar: lookup
  49. Almendarez M, Alvarez‐Velasco R, Pascual I, Alperi A, Moris C, Avanzas P. Transseptal puncture: review of anatomy, techniques, complications and challenges, a critical view. Int J Cardiol 2022;351:32–38.
    doi: 10.1016/j.ijcard.2022.01.011google scholar: lookup
  50. Chen K, Sang C, Dong J, Ma C. Transseptal puncture through amplatzer septal occluder device for catheter ablation of atrial fibrillation: use of balloon dilatation technique. J Cardiovasc Electrophysiol 2012;23:1139–1141.
    doi: 10.1111/j.1540-8167.2012.02306.xgoogle scholar: lookup
  51. Santangeli P. Right atrium to left ventricle puncture for vt ablation in patients with mechanical aortic and mitral valves: a step‐by‐step approach. J Cardiovasc Electrophysiol 2022;33:2094–2099.
    doi: 10.1111/jce.15467google scholar: lookup
  52. Vandecasteele T, Van Den Broeck W, Tay H, Couck L, van Loon G, Cornillie P. 3D reconstruction of the porcine and equine pulmonary veins, supplemented with the identification of telocytes in the horse. Anat Histol Embryol 2018;47:145–152.
    doi: 10.1111/ahe.12334google scholar: lookup
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