title: Modified Transseptal Puncture Technique in Challenging Septa: A Randomized Comparison to Conventional Technique.
abstract: Background. Transseptal puncture (TSP) can be challenging. We compared safety and efficacy of a modified TSP technique ("mosquito" technique, MOSQ-TSP) to conventional TSP (CONV-TSP).Method.Patients undergoing AF ablation in whom first attempt of TSP did not result in left atrial (LA) pressure (failure to cross, FTC) were randomized to MOSQ-TSP (i.e., puncture of the fossa via a wafer-thin inner stylet) or CONV-TSP (i.e., additional punctures at different positions). Primary endpoint was LA access. Secondary endpoints were safety, time, fluoroscopic dose (dose-area product, DAP), and number of additional punctures from FTC to final LA access.Result.Of 384 patients, 68 had FTC (MOSQ-TSP,n= 34 versus CONV-TSP,n= 34). No complications were reported. In MOSQ-TSP, primary endpoint was 100% (versus 73.5%,p< 0.002), median time to LA access was 72 s [from 37 to 384 s] (versus 326 s [from 75 s to 1936 s],p< 0.002), mean DAP to LA access was 1778 ± 2315 mGy/cm2(versus 9347 ± 10690 mGy/cm2,p< 0.002), and median number of additional punctures was 2 [1 to 3] (versus 0,p< 0.002).Conclusion.In AF patients in whom the first attempt of TSP fails, the "mosquito" technique allowseffective, safe, and time sparing LAaccess. This approach might facilitate TSP in elastic, aneurysmatic, or fibrosed septa.
authors.affiliation: Department of Cardiology, St Jan Hospital Bruges, Ruddershove 10, 8000 Bruges, Belgium.
authors.forename: Vikas
authors.initials: V
authors.lastname: Kataria
authors.affiliation: Department of Cardiology, St Jan Hospital Bruges, Ruddershove 10, 8000 Bruges, Belgium.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Berte
authors.affiliation: Department of Cardiology, St Jan Hospital Bruges, Ruddershove 10, 8000 Bruges, Belgium.
authors.forename: Yves
authors.initials: Y
authors.lastname: Vandekerckhove
authors.affiliation: Department of Cardiology, St Jan Hospital Bruges, Ruddershove 10, 8000 Bruges, Belgium.
authors.forename: Rene
authors.initials: R
authors.lastname: Tavernier
authors.affiliation: Department of Cardiology, St Jan Hospital Bruges, Ruddershove 10, 8000 Bruges, Belgium; University Hospital of Ghent, Ghent, Belgium.
authors.forename: Mattias
authors.identifier: 0000-0001-8451-0013
authors.initials: M
authors.lastname: Duytschaever
mesh_terms: D017115:Catheter Ablation / Q000379:methods*; D023381:Endpoint Determination; D005260:Female; D006346:Heart Septum / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009339:Needles; D011667:Pulmonary Veins / Q000473:pathology; D011677:Punctures / Q000379:methods*; D016896:Treatment Outcome