Published Online
on June 23, 2008

A more recent version of this article appeared on August 1, 2008

This Article Full Text (PDF) All Versions of this Article: 1/3/169    most recent CIRCEP.108.788000v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Google Scholar Articles by Knecht, S. Articles by Haïssaguerre, M. PubMed Articles by Knecht, S. Articles by Haïssaguerre, M. Related Collections Ablation/ICD/surgery Arrhythmias, clinical electrophysiology, drugs Related Article

Original Article

Radiofrequency puncture of the fossa ovalis for resistant transseptal access

Sébastien Knecht¹, Pierre Jaïs, Isabelle Nault, Matthew J. Wright, Seiichiro Matsuo, Antonio Madaffari, Nicolas Lellouche, Nicolas Derval, Mark D. O'Neill, Antoine Deplagne, Pierre Bordachar, Frédéric Sacher, Mélèze Hocini, Jacques Clémenty and Michel Haïssaguerre

Hôpital Cardiologique du Haut-L&eacutevêque; Univ. Victor Segalen, Bordeaux, France

Correspondence: ¹ E-mail: sebastien.knecht{at}chu-brugmann.be

Background—Transseptal puncture with a conventional mechanical technique can fail due to a resistant interatrial septum. We evaluated the efficacy and safety of a new method to cross resistant septae by transmitting radiofrequency (RF) energy through the transseptal needle.

Methods and Results—Among 269 consecutive transseptal punctures, 13 (5%) were unsuccessful in 12 different patients (11 men aged 52±12 years) using the conventional Brockenbrough technique. All 12 patients had previously undergone at least one transseptal catheterization. The needle position in relation to the fossa ovalis was assessed by fluoroscopy in orthogonal views and was confirmed with contrast injection and by visualizing the characteristic "tenting" of the fossa ovalis. Prior to using RF energy, there were a median of 6 unsuccessful attempts to perforate the septum conventionally, with one pericardial puncture (with a non significant effusion). RF transseptal puncture was then performed by delivering unipolar RF with manual contact between the ablation catheter and the proximal extremity of the needle at the patient's groin. RF transseptal puncture was achieved at the first attempt in all patients within a median of 1 second (IQ range 1 - 4) and without any complication. The only parameter predictive of a septum resistant to conventional puncture was the total number of transseptal catheterizations (3.2±1 vs. 1.8±1, p<0.001).

Conclusion—Transmission of radiofrequency energy from the ablation catheter up to the tip of the transseptal needle provides an easy and safe method for piercing the fossa ovalis when the conventional approach fails due to a resistant septum.

Key Words: Transseptal puncture • atrial fibrillation • left atrium access • radiofrequency • resistant septum

Related Article

Radiofrequency Puncture of the Fossa Ovalis for Resistant Transseptal Access

Sébastien Knecht, Pierre Jaïs, Isabelle Nault, Matthew Wright, Seiichiro Matsuo, Antonio Madaffari, Nicolas Lellouche, Mark D. O'Neill, Nicolas Derval, Antoine Deplagne, Pierre Bordachar, Frederic Sacher, Mélèze Hocini, Jacques Clémenty, and Michel Haïssaguerre
Circ Arrhythmia Electrophysiol 2008 1: 169-174. [Abstract] [Full Text] [PDF]