Abstract 17361: Reaccessing the Left Atrium After Transeptal Puncture: Comparision Between the Standard Puncture Technique and Radiofrequency Current Delivery Technique.
Introduction: Recently elettrocautery (RF) has been used to facilitate transeptal puncture (TSP) for left atrial (LA) ablation procedures. Whether this LA instrumentation facilitates the access to the left chamber while in the right atrium is unknown. We randomized transeptal access performed with the standard technique versus transeptal access facilitated by RF energy.
Methods: Sixty patients undergoing catheter ablation for atrial fibrillation have been included in this study. 30 patients had two TSP performed using two 8-French Mullins transseptal sheaths with the standard technique and 30 had two TSP performed using the RF current delivery via the transeptal needle. After obtaining the transeptal accesses, a circular and an ablation catheters were advanced into the LA. A second operator blinded to the access technique withdrew the ablation catheter and his sheath into the right atrium and tried to cross again the septum trough the previous access. Repeat instrumentation of the LA was classified as easy, moderate or difficult.
Results: After the TSP access with the standard technique, in 73% (22 pts) of cases repeat access was classified as difficult. In 4 cases access was not possible requiring a redo transeptal and in 4 cases was classified as easy. After transeptal puncture with RF in 67% (20 pts) of cases repeat access to the left atrium was considered easy, while in 9 cases (30%) was classified as moderate and in one case difficult. The mean fluoro time to re-access the LA by a second operator was significantly longer when the transeptal access was obtained with the standard technique as compared to the RF approach (5.5±0.8 min vs 2.4±0.6 min respectively p <0.001).
Conclusion: Transeptal puncture with the electrocuttery facilitates repeat access to the left atrium. This finding has interesting implications for both manual and robotic navigation and ablation.
- © 2010 by American Heart Association, Inc.