title: Accuracy and procedural characteristics of standard needle compared with radiofrequency needle transseptal puncture for structural heart interventions.
abstract: OBJECTIVE
  Our objectives were to assess for differences between standard and radiofrequency (RF) needle in procedural times, success, and spatial accuracy.
  
  
  BACKGROUND
  Targeted transseptal (TS) puncture is essential for structural heart interventions. Spatial accuracy of standard versus RF needle has not been reported.
  
  
  METHODS
  Consecutive patients undergoing structural heart interventions requiring TS puncture were studied retrospectively. A standard needle was alternated with a RF needle. Procedural success and times were recorded. Measurements based on intraprocedural transesophageal echocardiograms of the intended versus final TS crossing site were obtained. Pre-puncture and maximal tenting of the septum were also recorded.
  
  
  RESULTS
  Twenty-five patients underwent standard needle and 27 RF TS access. All RF needle attempts to cross were successful without an assistance wire. Three standard needle patients required assisted crossing. After failed TS access, two patients had successful RF TS access. TS procedural times significantly favored the RF needle for time from septum to puncture (P = 0.02). Both standard and RF access yielded accurate crossing with no significant differences between the intended and actual crossing site. Maximal tenting was significantly less with the RF needle (P = 0.004). There were no major complications.
  
  
  CONCLUSIONS
  In the hands of an experienced operator, there were no major clinically significant differences between the standard and RF needle approaches. However, procedural unassisted crossing success was higher with the RF needle approach as compared to standard needle. Procedural times and degree of septum tenting favored the RF over standard needle. Accuracy was similar with both approaches. RF was a successful strategy when standard needle failed. There were no major complications with either TS puncture strategy. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Division of Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, California.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Sharma
authors.affiliation: Division of Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, California.
authors.forename: Gagan D
authors.initials: GD
authors.lastname: Singh
authors.affiliation: Division of Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, California.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Smith
authors.affiliation: Division of Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, California.
authors.forename: Dali
authors.initials: D
authors.lastname: Fan
authors.affiliation: Division of Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, California.
authors.forename: Reginald I
authors.initials: RI
authors.lastname: Low
authors.affiliation: Division of Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, California.
authors.forename: Jason H
authors.initials: JH
authors.lastname: Rogers
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation*; D017548:Echocardiography, Transesophageal; D004867:Equipment Design; D005260:Female; D006346:Heart Septum / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D009339:Needles; D011677:Punctures; D012189:Retrospective Studies
keywords: atrium appendage; catheterization; mitral valve disease; percutaneous intervention; structural heart disease intervention; transesophageal echocardiography; transseptal