Co-Author(s):
Mansour Razminia, MD - St. Joseph Hospital, Amita Health, Director of Clinical Cardiac Electrophysiology
Swedish Hospital part of NorthShore University
5140 N California Ave, Chicago, IL 60625
Introduction | Objectives: Fluoroscopy exposure and long-term lead wear have known health risks. Optimization of fluoroscope parameters, electroanatomic mapping (EAM) and intracardiac echocardiography (ICE) reduce radiation exposure, but transseptal puncture (TSP) and procedural efficiency remain barriers to full adoption. This is the first reported fluoroless clinical experience using a new RF transseptal system that offers more efficient left atrial (LA) access through reduced device exchanges
Methods: Fluoroless RF and cryoballoon ablations at 2 centers were retrospectively reviewed. TSP was performed using the VersaCross RF system (Baylis Medical) comprised of a transseptal sheath, shapeable dilator and RF wire (J-tip or pigtail) that can be used to perform TSP. The wire was also used to deliver the FlexCath sheath (Medtronic) in cryoballoon ablations.  The RF wire tip was visualized as a discrete point on EAM. ICE was used to confirm wire, sheath and dilator location. Transseptal success, time, fluoroscopy use and procedural complications were evaluated
Results: Single (4) or double (19) TSP were performed 100% successfully with no fluoroscopy or lead use. Arrhythmias treated were: paroxysmal AF (10), persistent AF (8), long-standing persistent AF (2) and atrial tachycardia (4). Seven patients had prior ablation. TSP was achieved 14.2 ± 6.0 min (n=16) from procedure start or 3.5 ± 2.2 min (n=35) from RF wire insertion in the femoral vein. Visualization on ICE and EAM was achieved as the RF wire was advanced up to the SVC, sheath and dilator tracked over the wire, Wire pulled back, dropdown to the fossa ovalis with the wire exposed, and wire position in the LA to confirm TSP (Figure 1). No device exchanges were needed for TSP or repositioning on the septum after femoral access. There were no TSP-related complications. Subsequent RF (21) or cryoballoon (2) ablation was performed as per usual protocol
Conclusions: Our experience supports the feasibility of fluoroless TSP using the VersaCross RF system. Use of a multi-functional RF transseptal wire eliminated extra device exchanges and minimized the time to LA access. Larger comparative studies are needed to confirm safety and efficacy associated with the use of the RF transseptal wire
AFS 2021-30