Prospective comparison between conventional transseptal puncture and transseptal needle puncture with radiofrequency energy

Patients undergoing left atrial ablation require transseptal puncture, which can be challenging, even for experienced physicians. This study compared the efficacy and safety of radiofrequency (RF) energy transseptal punctures to conventional approach. Patients requiring transseptal puncture for left atrial access were included using either conventional approach or the NRG (TM) RF transseptal needle as first attempt. Procedure time for transseptal access, fluoroscopy time, crossover, and safety of both techniques were compared. A total of 241 transseptal punctures were performed in 148 consecutive patients (114 men, 54 +/- 10 years, left atrial volume 32 +/- 10 ml/m(2)) who underwent 157 procedures with left atrial access, mainly for atrial fibrillation. It was a repeat transseptal procedure in 49 patients. Procedures were guided by transesophageal echocardiography. RF transseptal puncture was planned in 119 procedures. RF was delivered in 98 procedures (82%) for 139/187 punctures: 48 punctures did not require RF, including 25 punctures performed by exposing the needle tip, 22 through patent foramen ovale, and 1 RF delivery failure by the generator. Average time for RF transseptal was 4.8 +/- 2.8 min compared to 7.5 +/- 8.5 min for conventional approach (p = 0.045). Fluoroscopy time was 1.8 +/- 1.3 min for RF transseptal and 2.9 +/- 2.8 min for standard approach (p = 0.043). Four patients required crossover to RF transseptal needle in the conventional group (p = 0.003). One tamponade occurred at the end of procedure in a patient using the RF needle, and one interatrial septum dissection with aortic root hematoma occurred in the conventional group. Transseptal needle puncture using RF energy can be performed safely and quickly under imaging guidance.