Radiofrequency puncture of the fossa ovalis for resistant transseptal access.
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.


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.
Knecht
Sébastien
S
Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France. sebastien.knecht@chu-brugmann.be
Jaïs
Pierre
P
Nault
Isabelle
I
Wright
Matthew
M
Matsuo
Seiichiro
S
Madaffari
Antonio
A
Lellouche
Nicolas
N
O'Neill
Mark D
MD
Derval
Nicolas
N
Deplagne
Antoine
A
Bordachar
Pierre
P
Sacher
Frederic
F
Hocini
Mélèze
M
Clémenty
Jacques
J
Haïssaguerre
Michel
M
D000328:Adult; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000601:surgery*; D054087:Atrial Septum / Q000601:surgery*; D006328:Cardiac Catheterization; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011677:Punctures / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome