Initial experience of a novel radiofrequency wire-based transseptal puncture system

• Published in: European journal of arrhythmia & electrophysiology 2022-01, Vol.8, p.49
• Main Authors: Wardak, F A, Paisey, J R, Bowers, R W, University Hospital Southampton NHS Foundation Trust, Southampton, Yue, A M, Roberts, PR, School of Human Development and Health, Faculty of Medicine, University of Southampton, Ullah, W
• Format: Article
• Language: English
• Subjects: Ablation
• ISSN: 2058-3869; 2058-3877

Background: Transseptal puncture is a key component of cardiac ablation and structural interventional procedures. The VersaCross RF transseptal puncture (TSP) platform (Baylis Medical) is a novel system comprising a blunt radiofrequency (RF) wire rather than a needle, passed through a malleable sheath/dilator. The wire forms a pigtail on deployment and is firm enough to exchange over. This study details the first experience of the use of this novel technology in Europe, and the first worldwide without echocardiographic guidance. Methods: Consecutive patients undergoing TSP were included in the VersaCross group followed by a control group using standard equipment. All 5 operators used the VersaCross system in 2–3 cases prior to data inclusion in the study. Interventions were performed under general anaesthetic or sedation, with transoesophageal echo (TOE) used in a subset to guide the puncture. TSP and fluoroscopy times were prospectively recorded from the point when the drop down from the superior vena cava (SVC) was started until the VersaCross sheath was passed into the left atrium (LA). For double transseptal access, the latter was taken as the time the second separate transseptal puncture was completed or, based on the operator’s preference, a second sheath had been passed into the LA through the initial puncture. Also recorded were the number of drop downs from the SVC and number of RF applications or needle deployments on the septum. Immediate and post-discharge complications were recorded. Results: The VersaCross (n=50) and control (n=25) groups had a mean age of 61.9 ± 11.1 years vs 64.2 ± 11.3 years; 54% vs 68% male; BMI of 29.1 ± 5.3 vs 29.3 ± 5.1; 34 vs 28% with prior TSP procedures; 98 vs 100% on anticoagulation; 10 vs 16% with pacemakers; and 38 vs 40% under TOE guidance (p>0.05 for all). Ablations for AF predominated in both groups (86 vs 92%), of which approximately half were cryoablations (49% vs 56%). The remaining cases were for atrial or ventricular tachycardia. For both single or dual transseptal access, there was no correlation between transseptal or fluoroscopy time and procedure number in the VersaCross group. There was no difference in transseptal or fluoroscopy time between the VersaCross and control groups (p>0.05 for all) (Figure 1). VersaCross cases needed an average of 1.5 ± 1 drop downs and 1 ± 0.7 RF application per TSP. For control cases this was 1.5 ± 0.9 and 1 ± 0.6 deployments, respectively (p>0.05 for both). In the Versa