Introduction
Transseptal puncture (TSP) is commonly performed using radiofrequency
(RF) or mechanical needles to obtain left atrial (LA) access during
procedures to treat heart rhythm disorders and structural heart
disease.1 Challenging TSP can occur due to anatomic
variability, as well as in patients with a history of multiple ablations
or congenital heart disease (CHD).2, 3 Performing TSP
on fibrotic or aneurysmal septa using traditional mechanical needles can
lead to lower success rates and a higher risk of
injury.4 In comparison, dedicated radiofrequency (RF)
transseptal needles have been shown to improve the rate of successful
left atrial cannulation, as well as reduce procedure
time5 and complications such as cardiac
tamponade5 and plastic particle
embolization6 even in cases of challenging
anatomy.4, 7, 8
While application of electrocautery to the proximal end of a mechanical
transseptal needle has been used to facilitate catheterization of
difficult septa, electrosurgical parameters have not been clearly
defined or optimized for TSP, and there is variability between operators
in power settings (20-50W), RF application times (up to 11s) and the
number of energy applications required.9-14 More
importantly, electrifying a hollow needle can cause coring of cardiac
tissue, presenting a risk of systemic embolization.15Use of electrocautery with standard metal guidewires has been proposed
as an alternative to perform TSP;16 however, the
safety and effectiveness of this approach is unknown. Standard
guidewires are not optimized for electrosurgical use and have been
associated with several complications during laparoscopic procedures
including guidewire fracture,17, 18 stripping of the
guidewire coating,19 as well as
electrical20 and thermal injury21-25to patients. Recently, a dedicated RF transseptal wire (VersaCross
Transseptal Solution, Baylis Medical, Montreal, Canada) has been shown
to be safe and effective at both performing TSP and reducing device
exchanges to improve procedural efficiency.26, 27 The
objective of this study was to compare the safety and effectiveness of
electrified guidewires (EG) to a dedicated RF transseptal wire in an ex
vivo porcine TSP model.