Use of a novel sharp-tip, J-shaped guidewire to facilitate transseptal catheterization.
OBJECTIVE
Transseptal catheterization (TSP-C) is a demanding procedure and at the same time one of the key points of atrial fibrillation ablation, an increasingly diffused procedure. This study prospectively evaluates the usefulness of a novel sharp-tip, J-shaped 0.014'' transseptal guidewire (TSP-GW) to facilitate TSP-C in case of resistant atrial septum (AS).


RESULTS
Consecutive patients undergoing TSP-C for arrhythmia ablation in a single centre were considered for the study. TSP-C was performed according to a standardized technique. The criterion to use the TSP-GW was a resistant AS, defined as inability to perforate the fossa ovalis by applying moderate pressure to a standard Brockenbrough needle. The TSP-GW was inserted in the needle lumen and advanced to puncture the AS and enter the left atrium; subsequently, the transseptal assembly was advanced over the TSP-GW. Double transseptal puncture was routinely performed for ablation of atrial fibrillation. Eighty-one patients (54 males, 27 females; mean age 54 +/- 17 years, range 12-81) undergoing TSP-C were enrolled; 132 TSP-C procedures were planned and accomplished. Nineteen patients (23%) in 27 procedures showed a resistant AS. In all these procedures, the TSP-GW was safely and successfully used to accomplish the TSP-C. In patients with a resistant AS, only a significantly lower prevalence of structural heart disease was observed when compared with controls. No complication related to TSP-C was observed.


CONCLUSIONS
The TSP-GW facilitates TSP-C in 23% of the patients, in whom a resistant AS is encountered. In this population, there was no clinical predictor of such anatomy.
Department of Heart, Brain and Vessels, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Viale Borri, 57, IT-21100 Varese, Italy. rdeponti@alice.it
Roberto
R
De Ponti
Raffaella
R
Marazzi
Giuseppe
G
Picciolo
Jorge A
JA
Salerno-Uriarte
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000601:surgery*; D054087:Atrial Septum / Q000601:surgery*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D016022:Case-Control Studies; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D002648:Child; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult