Transseptal puncture for the treatment of structural heart disease: conventional needle or radiofrequency needle?

Courtesy of Dr. José Álvarez.

This study sought to find differences in the transseptal puncture technique between the use of a conventional needle and the use of a radiofrequency-powered needle.

A total of 52 patients who underwent transseptal puncture for the treatment of various types of heart disease (Mitraclip, Watchman, Lariat, and mitral valvuloplasty) were retrospectively analyzed. A conventional needle was used in 25 cases (BRK, St Jude Medical) and a radiofrequency needle was used in the other 27 (Baylis Medical, Canada). All procedures included a transesophageal echocardiography; intended and actual puncture sites were analyzed in orthogonal views.

As a result, the puncture was effective in all cases in which a radiofrequency needle was used. As regards the conventional needle group, three patients required the use of an assistance wire to cross the septum and two patients had to be crossed over to the radiofrequency group. There were no differences as regards accuracy in the puncture site, but the time to septum crossing was lower for patients in the radiofrequency group. Septum tenting was higher in patients in the conventional needle group.

Editorial Comment

This is a retrospective observational study comparing two transseptal puncture techniques. Results were similar, except for a lower degree of septum tenting with a radiofrequency needle, which can be beneficial in cases in which the septum is lax and the conventional technique entails a risk of lesion to the left atrial lateral wall.

Courtesy of Dr. José Álvarez.

Original title: Accuracy and procedural characteristics of standard needle compared with radiofrequency needle transseptal puncture for structural heart interventions.

Authors: Gaufav Sharma MD, Gagan D Singh MD. Thomas Smith MD. Dali Fan MD, Reginald Low MD, Jason Rogers MD.

Reference: Cathet Cardiovasc Interv 2017; 89(6):E200-E206.

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