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