title: Feasibility, safety, and outcome of a challenging transseptal puncture facilitated by radiofrequency energy delivery: a prospective single-centre study.
abstract: OBJECTIVE
  Although it has been shown that a transseptal (TS) puncture in the electrophysiology laboratory is associated with a high success and a low complication rate, this procedure remains challenging particularly in difficult septum anatomies (aneurismal septum and thick septum) and during repeat TS catheterization. Radiofrequency (RF) electrocautery current delivery through the TS needle has been shown to facilitate the TS puncture. The aim of this study was to verify prospectively the feasibility, safety, and outcome of RF energy delivery associated with the standard TS technique in patients undergoing a challenging TS puncture.
  
  
  RESULTS
  Over a 14-month period, 162 consecutive patients underwent left atrial (LA) arrhythmia ablation in our centre. Among them, we enrolled 18 patients who failed LA access after two TS puncture attempts. In these patients, an RF delivery through TS (RF-TS) needle approach was used to reach the LA. All 18 patients had a successful RF-TS at the first attempt. A transoesophageal echocardiography (TEE) guidance and fluoroscopy views were used in all patients. No acute complications were reported. There have been no clinical sequelae after 10 +/- 4 months of follow-up following the RF-TS approach. Challenging TS punctures were more frequent in repeat LA catheterization when compared with the first LA catheterization, respectively, in 35% (13 of 37) and 4% (5 of 125) of the patients.
  
  
  CONCLUSIONS
  Radiofrequency electrocautery delivery associated with the standard TS approach is a safe and reproducible technique to reach the left atrium, using the TEE guidance. This technique is helpful during repeat TS catheterization and in the presence of anatomical atrial septum abnormalities.
authors.affiliation: Heart Rhythm Management Centre, UZ Brussel-VUB Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium. luciomassimo@hotmail.com
authors.forename: Lucio
authors.initials: L
authors.lastname: Capulzini
authors.forename: Gaetano
authors.initials: G
authors.lastname: Paparella
authors.forename: Antonio
authors.initials: A
authors.lastname: Sorgente
authors.forename: Carlo
authors.initials: C
authors.lastname: de Asmundis
authors.forename: Gian Battista
authors.initials: GB
authors.lastname: Chierchia
authors.forename: Andrea
authors.initials: A
authors.lastname: Sarkozy
authors.forename: Andreas
authors.initials: A
authors.lastname: Muller-Burri
authors.forename: Yoshinao
authors.initials: Y
authors.lastname: Yazaki
authors.forename: Markus
authors.initials: M
authors.lastname: Roos
authors.forename: Pedro
authors.initials: P
authors.lastname: Brugada
mesh_terms: D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000000981:diagnostic imaging / Q000601:surgery*; D054087:Atrial Septum / Q000000981:diagnostic imaging / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects* / Q000379:methods; D017548:Echocardiography, Transesophageal; D004564:Electrocoagulation / Q000009:adverse effects* / Q000379:methods; D022062:Electrophysiologic Techniques, Cardiac; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016896:Treatment Outcome