Use of a novel needle wire in patients undergoing transseptal puncture associated with severe septal tenting.
BACKGROUND
An increasing number of patients undergo left atrial ablation procedures, since several approaches have proven efficacy in the treatment of atrial fibrillation. Although transseptal catheterization was generally shown be a safe technique, it harbors the principal risk of cardiac injury. Therefore, there is a need for a safe and effective tool to enable transseptal puncture in difficult cases as well.


RESULTS
In 158 consecutive patients, a transseptal puncture was intended for mapping and ablation of left atrial tachycardias. In seven patients of this series transseptal puncture using different sheaths and needle designs, the operators failed to cross the interatrial septum as a result of severe tenting. Three patients were known to have a septal aneurysm; a redo procedure was performed in two patients. In the remaining patients, there was no obvious explanation for the difficulty in crossing the interatrial septum conventionally. In all seven patients, a 120-cm-long nitinol guidewire ("needle wire") with a 0.014-inch diameter was used to cross the atrial septum with the following idea: after tenting the fossa ovalis with the transseptal dilator and the Brockenbrough needle positioned just inside the tip, effortless advancement of the needle wire perforates the membranous fossa. Unsupported by the needle and dilator, the tip of the wire immediately assumes a "J" shape, rendering it incapable of further tissue penetration after its entry into the left atrium. In all seven patients, the needle wire could be placed into a left pulmonary vein. In five patients, a single attempt was sufficient to reach the left atrium with the wire, two patients needed two and three attempts, respectively. No complications occurred.


CONCLUSIONS
Additional use of a needle wire to perform transseptal puncture in a subset of patients at higher risk for complications appears safe and effective.
Wieczorek
Marcus
M
Department of Electrophysiology, Herzzentrum Duisburg, Gerrickstrasse 21, 47137 Duisburg, Germany. drmwieczorek@t-online.de
Hoeltgen
Reinhard
R
Akin
Elvan
E
Salili
Ali Reza
AR
D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000295:instrumentation* / Q000706:statistics & numerical data; D017115:Catheter Ablation / Q000295:instrumentation* / Q000706:statistics & numerical data; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D005858:Germany / Q000453:epidemiology; D006346:Heart Septum / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009339:Needles / Q000706:statistics & numerical data*; D015995:Prevalence; D011677:Punctures / Q000295:instrumentation* / Q000706:statistics & numerical data; D016896:Treatment Outcome