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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

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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]

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