Eliminating transseptal sheath exchange for pulsed field ablation procedures using a direct over-the-needle transseptal access with the Faradrive sheath

Kueffer, Thomas; Madaffari, Antonio; Thalmann, Gregor; Mühl, Aline; Galuszka, Oskar; Baldinger, Samuel H.; Seiler, Jens; Tanner, Hildegard; Kobza, Richard; Roten, Laurent; Berte, Benjamin; Reichlin, Tobias

doi:10.1093/europace/euad060

Cited by 10 publications

(6 citation statements)

References 6 publications

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“…Furthermore, eliminating the need for sheath exchange reduces the risk for air embolism. 7 Kueffer et al 8 studied the feasibility and safety of a direct over-theneedle transseptal access in the setting of PVI with PFA using a long 0.032 wire in 100 patients. The authors used a fluoroscopy-based LA access, whereas our strategy employs the use of a fluoroscopy and TEE-based LA access, as the TEE scope remains in position after ruling out LA thrombi (as described in the Methods section).…”

Section: Resultsmentioning

confidence: 99%

A zero‐exchange approach for left atrial access in pulmonary vein isolation with pulsed field ablation

Bejinariu,

Spieker,

Makimoto

et al. 2024

Cardiovasc electrophysiol

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IntroductionPulsed field ablation (PFA) has emerged as an innovative technique for pulmonary vein isolation (PVI). Typically, a transeptal puncture (TSP) with a standard sheath precedes a switch to the larger diameter sheath in the left atrium. This study aimed to describe the safety and feasibility of direct TSP using the large diameter Faradrive sheath before performing PVI with PFA.MethodsWe prospectively enrolled 166 consecutive patients with paroxysmal or persistent atrial fibrillation (AF) undergoing PVI with PFA at our institution. TSP was performed in all cases with transesophageal echocardiography guidance, using the Faradrive sheath and a 98 cm matched Brockenbrough needle. The primary endpoint was the occurrence of pericardial tamponade during or within the first 48 h after the procedure. The secondary endpoint was the occurrence of any major complication.ResultsAll 166 patients were included into the final analysis (44% female): 64% of patients had paroxysmal AF and 36% persistent AF (68 ± 11 years old, median CHA2DS2Vasc Score 3, median left atrial volume index 31). The median duration of the procedure was 60 min, median time to TSP was 15 min, and the median fluoroscopy dose was 595 cGy × cm2. The primary endpoint occurred in one patient: a non‐TSP related pericardial tamponade, which was managed with pericardial puncture.ConclusionDirect TSP with skipping sheath exchange using the large diameter Faradrive sheath for PVI with PFA was safe, feasible, and reduced costs in all patients. Large scale studies and registries are needed to verify this workflow.

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Section: Resultsmentioning

confidence: 99%

A zero‐exchange approach for left atrial access in pulmonary vein isolation with pulsed field ablation

Bejinariu,

Spieker,

Makimoto

et al. 2024

Cardiovasc electrophysiol

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“… 25 LA access was obtained by fluoroscopy-guided transseptal puncture either using a standard transseptal sheath, followed by an exchange to the 13F Faradrive sheath, or through a direct puncture using the 13F sheath, depending on the physician’s preference. 26 Heparin was administered to maintain an activated clotting time >350 seconds throughout the procedure.…”

Section: Methodsmentioning

confidence: 99%

Pulsed-field ablation for repeat procedures after failed prior thermal ablation for atrial fibrillation

Maurhofer,

Tanner,

Kueffer

et al. 2024

Heart Rhythm O2

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“… 12 Left atrial access was obtained by fluoroscopy-guided transseptal puncture either using a standard SL1 sheath, followed by an exchange to the 13F FARADRIVE sheath, or through a direct puncture using the 13F sheath, depending on the physician’s preference. 13 …”

Section: Methodsmentioning

confidence: 99%

Posterior wall ablation by pulsed-field ablation: procedural safety, efficacy, and findings on redo procedures

Kueffer,

Tanner,

Madaffari

et al. 2023

Europace

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Background The left atrial posterior wall is a potential ablation target in patients with recurrent atrial fibrillation despite durable pulmonary vein isolation or in patients with roof-dependent atrial tachycardia (AT). Pulsed-field ablation (PFA) offers efficient and safe posterior wall ablation (PWA), but available data is scarce. Methods Consecutive patients undergoing PWA using PFA were included. PWA was performed using a pentaspline PFA catheter and verified by 3D-electroanatomic mapping. Follow-up was performed using 7-day Holter-ECGs 3, 6, and 12 months after ablation. Recurrence of any atrial arrhythmia lasting more than 30 seconds was defined as failure. Lesion durability was assessed during redo procedures. Results PWA was performed in 215 patients (70% males, median age 70 [IQR 61-75] years, 67% redo procedures) and was successful in all patients (100%) by applying a median of 36 (IQR 32-44) PFA lesions. Severe adverse events were cardiac tamponade and vascular access complication in one patient each (0.9%). Median follow-up was 7.3 (IQR 5.0-11.8) months. One-year arrhythmia-free outcome in Kaplan-Meier analysis was 53%. A redo procedure was performed in 26 patients (12%) after a median of 6.9 (IQR 2.4-11) months and showed durable PWA in 22 patients (85%) with only minor lesion regression. Among 4 patients with posterior wall reconnection, 3 (75%) presented with roof-dependent AT. Conclusion PWA with this pentaspline PFA catheter can be safely and efficiently performed with a high durability observed during redo procedures. The added value of durable PWA for the treatment of atrial fibrillation remains to be evaluated.

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Eliminating transseptal sheath exchange for pulsed field ablation procedures using a direct over-the-needle transseptal access with the Faradrive sheath

Cited by 10 publications

References 6 publications

A zero‐exchange approach for left atrial access in pulmonary vein isolation with pulsed field ablation

A zero‐exchange approach for left atrial access in pulmonary vein isolation with pulsed field ablation

Pulsed-field ablation for repeat procedures after failed prior thermal ablation for atrial fibrillation

Posterior wall ablation by pulsed-field ablation: procedural safety, efficacy, and findings on redo procedures

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