Prospective comparison between conventional transseptal puncture and transseptal needle puncture with radiofrequency energy
- 19 April 2011
- journal article
- research article
- Published by Springer Science and Business Media LLC in Journal of Interventional Cardiac Electrophysiology
- Vol. 31 (3), 237-242
- https://doi.org/10.1007/s10840-011-9564-2
Abstract
Patients undergoing left atrial ablation require transseptal puncture, which can be challenging, even for experienced physicians. This study compared the efficacy and safety of radiofrequency (RF) energy transseptal punctures to conventional approach. Patients requiring transseptal puncture for left atrial access were included using either conventional approach or the NRG™ RF transseptal needle as first attempt. Procedure time for transseptal access, fluoroscopy time, crossover, and safety of both techniques were compared. A total of 241 transseptal punctures were performed in 148 consecutive patients (114 men, 54 ± 10 years, left atrial volume 32 ± 10 ml/m2) who underwent 157 procedures with left atrial access, mainly for atrial fibrillation. It was a repeat transseptal procedure in 49 patients. Procedures were guided by transesophageal echocardiography. RF transseptal puncture was planned in 119 procedures. RF was delivered in 98 procedures (82%) for 139/187 punctures: 48 punctures did not require RF, including 25 punctures performed by exposing the needle tip, 22 through patent foramen ovale, and 1 RF delivery failure by the generator. Average time for RF transseptal was 4.8 ± 2.8 min compared to 7.5 ± 8.5 min for conventional approach (p = 0.045). Fluoroscopy time was 1.8 ± 1.3 min for RF transseptal and 2.9 ± 2.8 min for standard approach (p = 0.043). Four patients required crossover to RF transseptal needle in the conventional group (p = 0.003). One tamponade occurred at the end of procedure in a patient using the RF needle, and one interatrial septum dissection with aortic root hematoma occurred in the conventional group. Transseptal needle puncture using RF energy can be performed safely and quickly under imaging guidance.Keywords
This publication has 19 references indexed in Scilit:
- Initial Experience Using a Radiofrequency Powered Transseptal NeedleJournal of Cardiovascular Electrophysiology, 2010
- Radiofrequency Transseptal Catheter Electrode FracturePacing and Clinical Electrophysiology, 2010
- The Use of a Standard Radiofrequency Energy Delivery System to Facilitate Transseptal PunctureJournal of Cardiovascular Electrophysiology, 2009
- Radiofrequency Puncture of the Fossa Ovalis for Resistant Transseptal AccessCirculation: Arrhythmia and Electrophysiology, 2008
- Usefulness of Transesophageal Echocardiography in the Isolation of Pulmonary Veins in the Treatment of Atrial FibrillationPacing and Clinical Electrophysiology, 2007
- Transatrial septal catheterization using a new radiofrequency probeCatheterization and Cardiovascular Interventions, 2005
- Radiofrequency perforation and conventional needle percutaneous transseptal left heart access: Pathological featuresCatheterization and Cardiovascular Interventions, 2005
- Transcatheter creation of atrial septal perforation using a radiofrequency transseptal system: Novel approach as an alternative to transseptal needle punctureCatheterization and Cardiovascular Interventions, 2005
- The technique and safety of transseptal left heart catheterization: the massachusetts general hospital experience with 1,279 proceduresCatheterization and Cardiovascular Diagnosis, 1994
- Transseptal left atrial puncture: New technique for the measurement of left atrial pressure in manThe American Journal of Cardiology, 1959