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.