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Knight BP, Wasserlauf J, Al-Dujaili S, Al-Ahmad A. Comparison of transseptal puncture using a dedicated RF wire versus a mechanical needle with and without electrification in an animal model. J Cardiovasc Electrophysiol 2024; 35:16-24. [PMID: 37890041 DOI: 10.1111/jce.16111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023]
Abstract
INTRODUCTION Mechanical force to achieve transseptal puncture (TSP) using a standard needle may lead to overshooting and injury, and can potentially be avoided using a radiofrequency (RF)-powered needle or wire. Applying electrocautery to needles and guidewires as an alternative to purpose-built RF systems has been associated with safety risks, such as tissue coring and thermal damage. The commercially available AcQCross needle-dilator system (Medtronic) features a sharp open-ended needle for mechanical puncture, as well as a built-in connector to enable energy delivery for RF puncture. This investigation compares the safety and efficacy of the AcQCross needle to the dedicated VersaCross RF wire system and generator (Baylis Medical/Boston Scientific). METHODS In an ex vivo porcine model, VersaCross wire punctures were performed using 1 s, constant mode (approx. 10 W) with maximum two attempts. AcQCross punctures were performed by applying energy for 2 s using a standard electrosurgical generator at 10 W (max. five attempts), 20 W (max. two attempts), and 30 W (max. two attempts). Efficacy was assessed in terms of puncture success and a number of energy applications required for TSP. Safety was assessed quantitatively as force required for TSP, energy required to puncture, and incidence of tissue coring, as well as by qualitative assessment of puncture sites. Additional qualitative observation of tissue cores and debris were obtained from TSP performed in live swine. RESULTS RF TSP was 100% successful using the VersaCross wire with 1.0 ± 0.0 attempts. When power was used with the AcQCross needle, it failed to puncture at low (10 and 20 W) power settings; TSP was achieved with 30 W of energy with 91% success using 1.53 ± 0.51 attempts (p < .05 vs. VC) with greater variability (F1,33 = 9223.5, p < .0001). Compared to RF puncture using the VersaCross system, mechanical puncture, alone, using the AcQcross needle required six times more force (8 mm additional forward device displacement) to perforate the septum. Qualitative assessment of puncture sites revealed larger defects and more tissue charring with the AcQCross needle at 30 W compared to punctures with VersaCross wire. Tissue coring with the open-ended AcQCross needle was observed in vivo and measured to occur in 57% of punctures using the ex vivo model; no coring was observed with the closed-tip VersaCross wire. CONCLUSIONS The AcQCross needle frequently required higher energy of 30 W to achieve RF TSP and was associated with tissue coring and charring, which have been, previously, reported when electrifying a standard open-ended mechanical needle or guidewire. These findings may limit safety and effectiveness compared to the VersaCross system.
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Affiliation(s)
- Bradley P Knight
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Jeremiah Wasserlauf
- Cardiovascular Institute, North Shore University Health System, Evanston, Illinois, USA
| | - Saja Al-Dujaili
- Department of Scientific Affairs, Boston Scientific Corporation, Mississauga, Ontario, Canada
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
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Khan A, Qureshi AM, Bansal M, Stapleton G, Webb MK, Lam W, Eilers L, Singh HR, Gowda ST. Extra-cardiac and complex Fontan baffle fenestration using radio frequency current via surgical electrocautery. Cardiol Young 2023; 33:2621-2627. [PMID: 37092668 DOI: 10.1017/s1047951123000380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND Fontan baffle punctures and creation of Fontan fenestration for cardiac catheterisation procedures remain challenging especially due to the heavy calcification of prosthetic material and complex anatomy. OBJECTIVES We sought to evaluate our experience using radiofrequency current via surgical electrocautery needle for Fontan baffle puncture to facilitate diagnostic, electrophysiology, and interventional procedures. METHODS A retrospective chart review of all Fontan patients (pts) who underwent Fontan baffle puncture using radiofrequency energy via surgical electrocautery from three centres were performed from January 2011 to July 2021. RESULTS A total of 19 pts underwent 22 successful Fontan baffle puncture. The median age and weight were 17 (3-36 years) and 55 (14-88) kg, respectively. The procedural indications for Fontan fenestration creation included: diagnostic study (n = 1), atrial septostomy and stenting (n = 1), electrophysiology study and ablation procedures (n = 8), Fontan baffle stenting for Fontan failure including protein-losing enteropathy (n = 7), and occlusion of veno-venous collaterals (n = 2) for cyanosis. The type of Fontan baffles included: extra-cardiac conduits (n = 12), lateral tunnel (n = 5), classic atrio-pulmonary connection (n = 1), and intra-cardiac baffle (n = 1). A Fontan baffle puncture was initially attempted using traditional method in 6 pts and Baylis radiofrequency trans-septal system in 2 pts unsuccessfully. In all pts, Fontan baffle puncture using radiofrequency energy via electrocautery needle was successful. The radiofrequency energy utilised was (10-50 W) and required 1-5 attempts for 2-5 seconds. There were no vascular or neurological complications. CONCLUSIONS Radiofrequency current delivery using surgical electrocautery facilitates Fontan baffle puncture in patients with complex and calcified Fontan baffles for diagnostic, interventional, and electrophysiology procedures.
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Affiliation(s)
- Asra Khan
- Pediatric Interventional Cardiology, Baylor College of Medicine, Texas Children's Hospital, 6651 Main Street, Suite E1920, Houston, TX 77030, USA
| | - Athar M Qureshi
- Pediatric Interventional Cardiology, Baylor College of Medicine, Texas Children's Hospital, 6651 Main Street, Suite E1920, Houston, TX 77030, USA
| | - Manish Bansal
- Pediatric Interventional Cardiology, Baylor College of Medicine, Texas Children's Hospital, 6651 Main Street, Suite E1920, Houston, TX 77030, USA
| | - Gary Stapleton
- Pediatric Interventional Cardiology, Baylor College of Medicine, Texas Children's Hospital, 6651 Main Street, Suite E1920, Houston, TX 77030, USA
| | - Melissa K Webb
- Pediatric Interventional Cardiology, Baylor College of Medicine, Texas Children's Hospital, 6651 Main Street, Suite E1920, Houston, TX 77030, USA
| | - Wilson Lam
- Pediatric Interventional Cardiology, Baylor College of Medicine, Texas Children's Hospital, 6651 Main Street, Suite E1920, Houston, TX 77030, USA
| | - Lindsay Eilers
- Pediatric Interventional Cardiology, Baylor College of Medicine, Texas Children's Hospital, 6651 Main Street, Suite E1920, Houston, TX 77030, USA
| | - Harinder R Singh
- The Children's Hospital of San Antonio, 333 N. Santa Rosa Street, San Antonio, TX 78207, USA
| | - Srinath T Gowda
- Pediatric Interventional Cardiology, Baylor College of Medicine, Texas Children's Hospital, 6651 Main Street, Suite E1920, Houston, TX 77030, USA
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Kaplan RM, Wasserlauf J, Knight BP. Transseptal Access: A Review of Contemporary Tools. J Cardiovasc Electrophysiol 2022; 33:1927-1931. [PMID: 35229417 PMCID: PMC9545840 DOI: 10.1111/jce.15428] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 11/28/2022]
Abstract
Transseptal left atrial catheterization is routinely used for many common catheter‐based interventions. Tools for transseptal catheterization have advanced over the recent years. Such tools include imaging advances with intracardiac echocardiology as well as an array of needles, wires, and dilators to achieve transseptal access with greater ease and safety. This study will discuss the contemporary tools for transseptal catheterization and guidance for difficult cases.
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Affiliation(s)
- Rachel M Kaplan
- Section of Electrophysiology, Division of Cardiology, Northwestern University, Feinberg School of Medicine
| | | | - Bradley P Knight
- Section of Electrophysiology, Division of Cardiology, Northwestern University, Feinberg School of Medicine
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Wasserlauf J, Knight BP. Comparing the safety and effectiveness of dedicated radiofrequency transseptal wires to electrified metal guidewires. J Cardiovasc Electrophysiol 2022; 33:371-379. [PMID: 34978365 PMCID: PMC9303383 DOI: 10.1111/jce.15341] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 11/10/2021] [Accepted: 12/06/2021] [Indexed: 12/04/2022]
Abstract
Background Application of electrocautery to a metal guidewire is used by some operators to perform transseptal puncture (TSP). Commercially available dedicated radiofrequency (RF) guidewires may represent a better alternative. This study compares the safety and effectiveness of electrified guidewires to a dedicated RF wire. Methods TSP was performed on freshly excised porcine hearts using an electrified 0.014″ or 0.032″ guidewire under various power settings and was compared to TSP using a dedicated RF wire with 5 W power (0.035″ VersaCross RF System, Baylis Medical). The primary endpoint was the number of attempts required to achieve TSP. Secondary endpoints included the rate of TSP failure, TSP consistency, the effect of the distance between the tip of the guidewire and the tip of the dilator, and effect of RF power output level. Qualitative secondary endpoints included tissue puncture defect appearance, thermal damage to the TSP guidewire or dilator, and tissue temperature using thermal imaging. Results The RF wire required on average 1.10 ± 0.47 attempts to cross the septum. The 0.014″ electrified guidewire required an overall mean of 2.17 ± 2.36 attempts (2.0 times as many as the RF wire; p < .01), and the 0.032″ electrified guidewire required an overall mean of 3.90 ± 2.93 attempts (3.5 times as many as the RF wire; p < .01). Electrified guidewires had a higher rate of TSP failure, and caused larger defects and more tissue charring than the RF wire. Thermal analysis showed higher temperatures and a larger area of tissue heating with electrified guidewires than the RF wire. Conclusion Fewer RF applications were required to achieve TSP using a dedicated RF wire compared to an electrified guidewire. Smaller defects and lower tissue temperatures were also observed using the RF wire. Electrified guidewires required greater energy delivery and were associated with equipment damage and tissue charring, which may present a risk of thrombus, thermal injury, or scarring.
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Affiliation(s)
- Jeremiah Wasserlauf
- Department of Internal Medicine, Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Bradley P Knight
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Tokuda M, Yamashita S, Matsuo S, Kato M, Sato H, Oseto H, Okajima E, Ikewaki H, Isogai R, Tokutake K, Yokoyama K, Narui R, Tanigawa SI, Inada K, Yoshimura M, Yamane T. Radiofrequency needle for transseptal puncture is associated with lower incidence of thromboembolism during catheter ablation of atrial fibrillation: propensity score-matched analysis. Heart Vessels 2018; 33:1238-1244. [DOI: 10.1007/s00380-018-1159-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 03/30/2018] [Indexed: 11/24/2022]
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Gowda ST, Qureshi AM, Turner D, Madan N, Weigand J, Lorber R, Singh HR. Transseptal puncture using surgical electrocautery in children and adults with and without complex congenital heart disease. Catheter Cardiovasc Interv 2017; 90:E46-E54. [PMID: 28766834 DOI: 10.1002/ccd.27202] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 06/15/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND Atrial transseptal puncture (TSP) for cardiac catheterization procedures remain challenging in children and adults with complex congenital heart disease (CHD). OBJECTIVES We sought to evaluate our experience using radiofrequency (RF) current via surgical electrocautery needle for TSP to facilitate diagnostic and interventional procedures. METHODS Retrospective chart review of all patients (pts) who underwent TSP using RF energy (10-25 W) via surgical electrocautery from three centers from January 2011 to January 2017 were evaluated. Echocardiograms were reviewed to define the atrial septum as normal and complex (thin aneurysmal, thick/fibrotic, synthetic patch material, and extra cardiac conduit). RESULTS A total of 54 pts underwent 55 successful TSP. Median age was 12.5 years (1 day-54 years) and weight was 52.7 kg (2-162). Indications for TSP included; EP study and ablation procedures in structurally normal hearts (n = 24) and in complex atrial septum/CHD and structural heart disease pts (n = 30): Electrophysiology study and ablation in 4, diagnostic catheterization in 9, and interventional procedures in 17 pts were performed. Atrial TSP was successful in 54/55 (98%). Atrial perforation with tiny-small pericardial effusion not requiring intervention was noted in 2 pts. TSP was unsuccessful in one critically ill neonate with unobstructed TAPVR and restricted atrial septum who experienced cardiac arrest requiring CPR, ECMO, and emergent surgery. CONCLUSIONS RF current delivery using surgical electrocautery for TSP is a feasible and an effective option in patients with complex CHD for diagnostic, interventional, and electrophysiology procedures.
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Affiliation(s)
- Srinath T Gowda
- Pediatric Cardiology, The Children's Hospital of San Antonio, Baylor College of Medicine, San Antonio, Texas.,Pediatric Cardiology, Children's Hospital of Michigan, Detroit Medical Center, Detroit, Michigan
| | - Athar M Qureshi
- Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Daniel Turner
- Pediatric Cardiology, Children's Hospital of Michigan, Detroit Medical Center, Detroit, Michigan
| | - Nitin Madan
- Pediatric Cardiology, The Children's Hospital of San Antonio, Baylor College of Medicine, San Antonio, Texas
| | - Justin Weigand
- Pediatric Cardiology, The Children's Hospital of San Antonio, Baylor College of Medicine, San Antonio, Texas
| | - Richard Lorber
- Pediatric Cardiology, The Children's Hospital of San Antonio, Baylor College of Medicine, San Antonio, Texas
| | - Harinder R Singh
- Pediatric Cardiology, The Children's Hospital of San Antonio, Baylor College of Medicine, San Antonio, Texas.,Pediatric Cardiology, Children's Hospital of Michigan, Detroit Medical Center, Detroit, Michigan
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Comparison of a Radiofrequency Powered Flexible Needle with a Classic Rigid Brockenbrough Needle for Transseptal Punctures in Terms of Safety and Efficacy. Heart Lung Circ 2015; 24:173-8. [DOI: 10.1016/j.hlc.2014.07.073] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 04/29/2014] [Accepted: 07/28/2014] [Indexed: 12/26/2022]
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ESCH JESSEJ, TRIEDMAN JOHNK, CECCHIN FRANK, ALEXANDER MARKE, WALSH EDWARDP. Radiofrequency-Assisted Transseptal Perforation for Electrophysiology Procedures in Children and Adults with Repaired Congenital Heart Disease. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 36:607-11. [DOI: 10.1111/pace.12092] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Revised: 10/24/2012] [Accepted: 11/24/2012] [Indexed: 12/01/2022]
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Transseptal access for pulmonary vein isolation in a patient with atrial septal closure device: Use of electrocautery and atrial septostomy. Heart Rhythm 2011; 8:901-4. [DOI: 10.1016/j.hrthm.2011.01.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Accepted: 01/10/2011] [Indexed: 11/18/2022]
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10
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Winkle RA, Mead RH, Engel G, Patrawala RA. The use of a radiofrequency needle improves the safety and efficacy of transseptal puncture for atrial fibrillation ablation. Heart Rhythm 2011; 8:1411-5. [PMID: 21699841 DOI: 10.1016/j.hrthm.2011.04.032] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2011] [Accepted: 04/29/2011] [Indexed: 12/14/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) ablation requires transseptal puncture to gain entry to the left atrium (LA). On rare occasions, LA entry cannot be achieved or cardiac perforation results in pericardial tamponade. OBJECTIVE This study sought to compare a new radiofrequency (RF) transseptal needle with the standard needle. METHODS We evaluated 1,550 AF ablations in 1,167 patients. We compared 975 transseptal punctures done using a standard needle to 575 done using a new electrode-tipped needle attached to an RF perforation generator. RESULTS The rate of failure to cross the atrial septum was lower for the RF needle (1 of 575 [0.17%] vs. 12 of 975 [1.23%], P = .039) and there were fewer pericardial tamponades with the RF needle (0 of 575 [0.00%] vs. 9 of 975 [0.92%], P = .031). Multivariate analysis showed the RF needle use was the only variable associated with a lower incidence of tamponade (P = .04). Becasuse the RF needle was used later in our series, we examined our 975 standard needle punctures over time for evidence of improved operator experience that might explain the superior RF results. For the standard needle, there was no trend for improved septal crossing rates (P = .794) or fewer tamponades (P = .456) with more operator experience. Instrumentation time was shorter for the RF needle (27.1 ± 10.9 vs. 36.4 ± 17.7 minutes, P < .0001). CONCLUSION Our data suggest that the RF needle is superior to the standard transseptal needle. It results in shorter instrumentation times, a greater efficacy in transseptal crossing, and fewer episodes of pericardial tamponade.
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Affiliation(s)
- Roger A Winkle
- Cardiovascular Medicine and Cardiac Arrhythmias, East Palo Alto, California 94303, USA.
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Fromentin S, Sarrazin JF, Champagne J, Nault I, Philippon F, Molin F, Blier L, O’Hara G. Prospective comparison between conventional transseptal puncture and transseptal needle puncture with radiofrequency energy. J Interv Card Electrophysiol 2011; 31:237-42. [DOI: 10.1007/s10840-011-9564-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 03/04/2011] [Indexed: 10/18/2022]
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Crystal MA, Mirza MA, Benson LN. A radiofrequency transseptal needle: Initial animal studies. Catheter Cardiovasc Interv 2010; 76:769-73. [DOI: 10.1002/ccd.22600] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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13
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Knecht S, Jaïs P, Nault I, Wright M, Matsuo S, Madaffari A, Lellouche N, O'Neill MD, Derval N, Deplagne A, Bordachar P, Sacher F, Hocini M, Clémenty J, Haïssaguerre M. Radiofrequency Puncture of the Fossa Ovalis for Resistant Transseptal Access. Circ Arrhythm Electrophysiol 2008; 1:169-74. [DOI: 10.1161/circep.108.788000] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sébastien Knecht
- From the Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Pierre Jaïs
- From the Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Isabelle Nault
- From the Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Matthew Wright
- From the Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Seiichiro Matsuo
- From the Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Antonio Madaffari
- From the Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Nicolas Lellouche
- From the Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Mark D. O'Neill
- From the Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Nicolas Derval
- From the Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Antoine Deplagne
- From the Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Pierre Bordachar
- From the Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Frederic Sacher
- From the Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Mélèze Hocini
- From the Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Jacques Clémenty
- From the Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Michel Haïssaguerre
- From the Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France
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Fossa ovalis radiofrequency perforation in a difficult case of conventional transseptal puncture for atrial fibrillation ablation. J Interv Card Electrophysiol 2008; 21:249-53. [PMID: 18274714 DOI: 10.1007/s10840-007-9194-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2007] [Accepted: 12/04/2007] [Indexed: 12/12/2022]
Abstract
A 65-year-old man was referred for atrial fibrillation ablation to our center. Routine pre-procedure transthoracic and transoesophageal echocardiography and cardiac computed tomography examinations showed a normal interatrial septum and fossa ovalis anatomy. Access to left atrium was initially planned using a conventional transseptal needle puncture. During the procedure, several consecutive attempts in conjunction with intracardiac echocardiography support, failed to cross the septum. The procedure was then successfully carried out using a specifically designed radiofrequency transseptal catheter.
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Elagha AA, Kim AH, Kocaturk O, Lederman RJ. Blunt atrial transseptal puncture using excimer laser in swine. Catheter Cardiovasc Interv 2008; 70:585-90. [PMID: 17896413 PMCID: PMC2726716 DOI: 10.1002/ccd.21257] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVES We describe a new approach that may enhance safety of atrial transseptal puncture using a commercially available laser catheter that is capable of perforation only when energized. We test this approach in swine. BACKGROUND Despite wide application, conventional needle transseptal puncture continues to risk inadvertent nontarget perforation and its consequences. METHODS We used a commercial excimer laser catheter (0.9-mm Clirpath, Spectranetics). Perforation force was compared in vitro with a conventional Brockenbrough needle. Eight swine underwent laser transseptal puncture under X-ray fluoroscopy steered using a variety of delivery catheters. RESULTS The 0.9-mm laser catheter traversed in vitro targets with reduced force compared with a Brockenbrough needle. In vitro, the laser catheter created holes that were 25-30% larger than the Brockenbrough needle. Laser puncture of the atrial septum was successful and accurate in all animals, evidenced by oximetry, pressure, angiography, and necropsy. The laser catheter was steered effectively using a modified Mullins introducer sheath and using two different deflectable guiding catheters. The mean procedure time was 15 +/- 6 min, with an average 3.0 +/- 0.8 sec of laser activation. There were no adverse sequelae after prolonged observation. Necropsy revealed discrete 0.9-mm holes in all septae. CONCLUSION Laser puncture of the interatrial septum is feasible and safe in swine, using a blunt laser catheter that perforates tissues in a controlled fashion.
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Affiliation(s)
- Abdalla A Elagha
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
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