Abstract
Introduction. The application of radiofrequency (RF) electrocautery to a standard, open-ended transseptal needle has been used to facilitate transseptal puncture (TSP). The purpose of this study was to determine the incidence of cardiac tissue coring when this technique is used. Methods. A model using excised swine hearts submerged in a saline-filled basin was developed to simulate TSP with electrocautery and a standard transseptal needle. Four types of adult Brockenbrough needles and two different size swine hearts were used. Punctures were performed without the use of electrocautery, and by delivering RF energy to the transseptal needle using a standard Bovie electrocautery pen and an RF generator set to 10W and 15W, in both “pure” and “blend” cut settings, at three target sites (Fossa Ovalis [FO], non-Fossa Ovalis septum [Non-FO], and Aortic [AO]). The tissue of the submerged heart was gently tented, and the needle was advanced on delivery of RF. The devices were retracted, and the needle was flushed in a collection basin. The basin was inspected for tissue. Results. See Figure. None of the TSPs without cautery caused tissue coring. For TSP's using electrocautery, the frequency of coring was at least 21% for any puncture permutation used in the study, and averaged 37% at septal sites (p < 0.05 compared to punctures without cautery). Tissue coring occurred in 33/96 (35%) punctures through the FO, and 38/96 (40%) punctures through non-FO septum (Figure 3a). The frequency of tissue coring at aortic sites was 62/96 (65%), which was significantly higher than at the septal sites (p<0.001). Conclusions. In an animal preparation, TSP at the level of the fossa ovalis using electrocautery and a standard open-ended Brockenbrough needle resulted in coring of the septal tissue in one third of cases. These results raise concern about the risk of systemic embolism of cardiac tissue when this technique is used in humans.
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