Donate Help Contact The AHA Sign In Home
American Heart Association
Circulation: Arrhythmia and Electrophysiology
Search: search_blue_button Advanced Search
Circulation: Arrhythmia and Electrophysiology. 2008;1:169-174
Published online before print June 23, 2008, doi: 10.1161/CIRCEP.108.788000
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
1/3/169    most recent
CIRCEP.108.788000v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Knecht, S.
Right arrow Articles by Haïssaguerre, M.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Knecht, S.
Right arrow Articles by Haïssaguerre, M.
Related Collections
Right arrow Arrhythmias, clinical electrophysiology, drugs
Right arrow Ablation/ICD/surgery
Right arrowRelated Article

Original Articles

Radiofrequency Puncture of the Fossa Ovalis for Resistant Transseptal Access

Sébastien Knecht, MD; Pierre Jaïs, MD; Isabelle Nault, MD; Matthew Wright, MBBS, PhD; Seiichiro Matsuo, MD; Antonio Madaffari, MD; Nicolas Lellouche, MD; Mark D. O'Neill, MBBCh, DPhil; Nicolas Derval, MD; Antoine Deplagne, MD; Pierre Bordachar, MD; Frederic Sacher, MD; Mélèze Hocini, MD; Jacques Clémenty, MD and Michel Haïssaguerre, MD

From the Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France.

Correspondence to Sébastien Knecht, MD, Service de Rythmologie, Hôpital Cardiologique du Haut-L’évêque, Avenue de Magellan, 33604 Bordeaux-Pessac, France. E-mail sebastien.knecht{at}chu-brugmann.be

Received April 22, 2008; accepted June 3, 2008.

Background— Transseptal puncture with a conventional mechanical technique can fail because of 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 1 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. Before using RF energy, there were a median of 6 unsuccessful attempts to perforate the septum conventionally, with 1 pericardial puncture (with a nonsignificant 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 (interquartile range, 1 to 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 versus 1.8±1, P<0.001).

Conclusion— Transmission of RF 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 because of a resistant septum.

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


 

CLINICAL PERSPECTIVE


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]



This article has been cited by other articles:


Home page
J Am Coll CardiolHome page
S. S. Kim, Z. M. Hijazi, R. M. Lang, and B. P. Knight
The use of intracardiac echocardiography and other intracardiac imaging tools to guide noncoronary cardiac interventions.
J. Am. Coll. Cardiol., June 9, 2009; 53(23): 2117 - 2128.
[Abstract] [Full Text] [PDF]