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Radiofrequency puncture of the fossa ovalis for resistant transseptal access.
Circ Arrhythm Electrophysiol. 2008 Aug; 1(3):169-74.CA

Abstract

BACKGROUND

Transseptal puncture with a conventional mechanical technique can fail because of a resistant interatrial septum. We evaluated the efficacy and safety of a new method to cross-resistant septae by transmitting radiofrequency (RF) energy through the transseptal needle.

METHODS AND RESULTS

Among 269 consecutive transseptal punctures, 13 (5%) were unsuccessful in 12 different patients (11 men aged 52+/-12 years) using the conventional Brockenbrough technique. All 12 patients had previously undergone at least 1 transseptal catheterization. The needle position in relation to the fossa ovalis was assessed by fluoroscopy in orthogonal views and was confirmed with contrast injection and by visualizing the characteristic "tenting" of the fossa ovalis. Before using RF energy, there were a median of 6 unsuccessful attempts to perforate the septum conventionally, with 1 pericardial puncture (with a nonsignificant effusion). RF transseptal puncture was then performed by delivering unipolar RF with manual contact between the ablation catheter and the proximal extremity of the needle at the patient's groin. RF transseptal puncture was achieved at the first attempt in all patients within a median of 1 second (interquartile range, 1 to 4) and without any complication. The only parameter predictive of a septum resistant to conventional puncture was the total number of transseptal catheterizations (3.2+/-1 versus 1.8+/-1, P<0.001).

CONCLUSIONS

Transmission of RF energy from the ablation catheter up to the tip of the transseptal needle provides an easy and safe method for piercing the fossa ovalis when the conventional approach fails because of a resistant septum.

Authors+Show Affiliations

Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France. sebastien.knecht@chu-brugmann.beNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19808411

Citation

Knecht, Sébastien, et al. "Radiofrequency Puncture of the Fossa Ovalis for Resistant Transseptal Access." Circulation. Arrhythmia and Electrophysiology, vol. 1, no. 3, 2008, pp. 169-74.
Knecht S, Jaïs P, Nault I, et al. Radiofrequency puncture of the fossa ovalis for resistant transseptal access. Circ Arrhythm Electrophysiol. 2008;1(3):169-74.
Knecht, S., Jaïs, P., Nault, I., Wright, M., Matsuo, S., Madaffari, A., Lellouche, N., O'Neill, M. D., Derval, N., Deplagne, A., Bordachar, P., Sacher, F., Hocini, M., Clémenty, J., & Haïssaguerre, M. (2008). Radiofrequency puncture of the fossa ovalis for resistant transseptal access. Circulation. Arrhythmia and Electrophysiology, 1(3), 169-74. https://doi.org/10.1161/CIRCEP.108.788000
Knecht S, et al. Radiofrequency Puncture of the Fossa Ovalis for Resistant Transseptal Access. Circ Arrhythm Electrophysiol. 2008;1(3):169-74. PubMed PMID: 19808411.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Radiofrequency puncture of the fossa ovalis for resistant transseptal access. AU - Knecht,Sébastien, AU - Jaïs,Pierre, AU - Nault,Isabelle, AU - Wright,Matthew, AU - Matsuo,Seiichiro, AU - Madaffari,Antonio, AU - Lellouche,Nicolas, AU - O'Neill,Mark D, AU - Derval,Nicolas, AU - Deplagne,Antoine, AU - Bordachar,Pierre, AU - Sacher,Frederic, AU - Hocini,Mélèze, AU - Clémenty,Jacques, AU - Haïssaguerre,Michel, Y1 - 2008/06/23/ PY - 2009/10/8/entrez PY - 2008/8/1/pubmed PY - 2009/10/29/medline SP - 169 EP - 74 JF - Circulation. Arrhythmia and electrophysiology JO - Circ Arrhythm Electrophysiol VL - 1 IS - 3 N2 - BACKGROUND: Transseptal puncture with a conventional mechanical technique can fail because of a resistant interatrial septum. We evaluated the efficacy and safety of a new method to cross-resistant septae by transmitting radiofrequency (RF) energy through the transseptal needle. METHODS AND RESULTS: Among 269 consecutive transseptal punctures, 13 (5%) were unsuccessful in 12 different patients (11 men aged 52+/-12 years) using the conventional Brockenbrough technique. All 12 patients had previously undergone at least 1 transseptal catheterization. The needle position in relation to the fossa ovalis was assessed by fluoroscopy in orthogonal views and was confirmed with contrast injection and by visualizing the characteristic "tenting" of the fossa ovalis. Before using RF energy, there were a median of 6 unsuccessful attempts to perforate the septum conventionally, with 1 pericardial puncture (with a nonsignificant effusion). RF transseptal puncture was then performed by delivering unipolar RF with manual contact between the ablation catheter and the proximal extremity of the needle at the patient's groin. RF transseptal puncture was achieved at the first attempt in all patients within a median of 1 second (interquartile range, 1 to 4) and without any complication. The only parameter predictive of a septum resistant to conventional puncture was the total number of transseptal catheterizations (3.2+/-1 versus 1.8+/-1, P<0.001). CONCLUSIONS: Transmission of RF energy from the ablation catheter up to the tip of the transseptal needle provides an easy and safe method for piercing the fossa ovalis when the conventional approach fails because of a resistant septum. SN - 1941-3084 UR - https://www.unboundmedicine.com/medline/citation/19808411/Radiofrequency_puncture_of_the_fossa_ovalis_for_resistant_transseptal_access_ L2 - http://www.ahajournals.org/doi/full/10.1161/CIRCEP.108.788000?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -