Applying Runthrough Guidewire To Transseptal Puncture Without Iodinated Contrast Agent

Aims: Conventional transseptal puncture(TSP) relies on fluoroscopy and iodinated contrast agent to distinctly position the transseptal needle at the left atrium, however, there exists great challenges in clinic in patients with contrast hypersensitivity or allergy-like reactionsin the procedure. This study aimed to evaluate a novel approach to TSP assisted by Runthrough guidewire and fluoroscopy without use of iodinated contrast agent. Methods: Sixty patients with paroxysmal atrial fibrillation undergone radiofrequency catheter ablation were enrolled from February 2021 to October 2021, and randomised to routine TSP group and Runthrough guidewire assisted group. The two groups were compared regarding the total operative time, length of fluoroscopy exposure, difference of radiation dose in X-ray, and the safety was evaluated in the patients undergone TSP without iodinated contrast agent. Results: There were no differences in baseline demographics or clinical characteristics between the two groups. Although the total procedure time[(1.98±0.29) min vs.(2.11±0.14) min, P<0.04],length of fluoroscopic exposure [(1.83±0.30) vs.(1.98±0.14), P<0.19] and radiation dose in X-ray[(27.83±3.21) uGym2vs.(29.13±1.57) uGym2, P<0.30] were somewhat statistically different between groups, yet the difference was insignificant. No complications, including pericardial tamponade and aortic perforation, occurred in all patients. Conclusion: Iodine-free TSP under the guidance of Runthrough guidewire and fluoroscopy can be a simple, safe, economical and effective approach to TSP, and may be reproduced as a novel option for TSP in patients with contrast hypersensitivity or allergy-like reactions.