Real-time, three-dimensional localization of a Brockenbrough needle during transseptal catheterization using a nonfluoroscopic mapping system

We describe a new technique that allows real-time, three-dimensional (3-D) localization of the Brockenbrough needle tip during transseptal catheterization using the EnSite NavX system. Transseptal catheterization has been traditionally performed using fluoroscopy, and recently, with the use of intracardiac echocardiography. However, even intracardiac echocardiography has the limitation of providing only 2-D views limited to the ultrasound plane. By displaying the transseptal needle on the EnSite NavX system, we achieved real-time 3-D localization of the needle tip within the right atrial geometry and found accurate visual correlation between fluoroscopy, intracardiac echocardiography and nonfluoroscopic 3-D cardiac mapping. This study suggests that the EnSite NavX system is able to provide 3-D localization of the transseptal needle during transseptal catheterization, and may be a useful imaging modality in this procedure.