Radiofrequency current delivery via transseptal needle to facilitate septal puncture

Abstract

Transseptal catheterization is a technique that has been used since the late 1950s to gain percutaneous access to the left atrium (LA). 1 De Ponti R. Zardini M. Stori C. Longobardi M. Salerno-Uriarte J.A. Trans-septal catheterization for radiofrequency catheter ablation of cardiac arrhythmias. Eur Heart J. 1998; 19: 943-950 Crossref PubMed Scopus (82) Google Scholar With the advent of catheter-based approaches to intervene on diseased mitral valves and cardiac arrhythmias, the need for access to the LA has increased. At present, multiple modalities including traditional fluoroscopic guidance and intracardiac pressure monitoring with either transesophageal echocardiography or intracardiac echocardiography (ICE) are available to assist transseptal access. 2 Daoud E.G. Transseptal catheterization. Heart Rhythm. 2005; 2: 212-214 Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar Despite increased operator experience and better visualization when performing transseptal catheterization, there are several clinical settings in which crossing the septum is very difficult or impossible. 3 Marcus G.M. Ren X. Tseng Z.H. Badhwar N. Lee B.K. Lee R.J. Foster E. Olgin J.E. Repeat transseptal catheterization after ablation for atrial fibrillation. J Cardiovasc Electrophysiol. 2007; 18: 55-59 Crossref PubMed Scopus (60) Google Scholar These include patients undergoing repeat transseptal access, patients with cardiac surgical repair involving the interatrial septum, or patients with anatomic variants including lipomatous or aneurysmal interatrial septal deformity. To overcome these challenges, techniques that use active methods such as dedicated radiofrequency (RF) systems to perforate the septum and other cardiac structures have been developed and used clinically. 4 Justino H. Benson L.N. Nykanen D.G. Transcatheter creation of an atrial septal defect using radiofrequency perforation. Catheter Cardiovasc Interv. 2001; 54: 83-87 Crossref PubMed Scopus (48) Google Scholar , 5 Benson L.N. Nykanen D. Collison A. Radiofrequency perforation in the treatment of congenital heart disease. Catheter Cardiovasc Interv. 2002; 56: 72-82 Crossref PubMed Scopus (31) Google Scholar , 6 Pedra C.A. Filho R.M. Arrieta R.S. Tellez R. Fontes V.F. Recanalization of a discrete atretic right pulmonary artery segment with a new radiofrequency system. Catheter Cardiovasc Interv. 2003; 60: 82-87 Crossref PubMed Scopus (8) Google Scholar