Fluoroless left atrial access for radiofrequency and cryoballoon ablations using a novel radiofrequency transseptal wire

Abstract

Purpose Conventional catheter ablation for atrial fibrillation requires fluoroscopy, which has inherent risks of radiation exposure to patients and medical staff. Optimization of fluoroscopy parameters and use of three-dimensional electroanatomic mapping (EAM) and intracardiac echocardiography (ICE) have helped to reduce radiation exposure; however, despite growing evidence, there are still concerns about safety and added procedure time associated with fluoroless procedures, particularly in left-sided ablations, due to the potential risk of complications. Herein, we report our initial experience using a radiofrequency (RF) wire for completely fluoroless radiofrequency ablation (RFA) and cryoballoon ablation (CBA). Methods A retrospective analysis was conducted on ablation procedures for various cardiac arrhythmias performed non-fluoroscopically at two centers using the VersaCross RF wire transseptal system under EAM and ICE guidance. Results A total of 72 and 54 patients underwent RFA and CBA, respectively, successfully without any procedural complications. Transseptal access time for RFA was 14.5 ± 6.6 min from procedure start (including sheath and catheter placements ± right-sided ablation) or 2.8 ± 1.0 min from RF wire insertion into the femoral introducer. Transseptal access time for CBA was 19.2 ± 11.7 min from procedure start (including sheath and catheter placements ± right-sided ablation) or 3.5 ± 1.6 min from RF wire insertion into the femoral introducer. Average procedure time was 104.4 ± 38.0 min for RFA and 91.1 ± 22.1 min for CBA. Conclusions A RF wire can be used to achieve completely fluoroless transseptal puncture safely and effectively while improving procedural efficiency in both RFA and CBA.

Improved Left Atrial Catheterization Efficiency and Consistency using a novel steerable transseptal puncture sheath

“…By eliminating the RF needle and additional sheath exchange, time to transseptal puncture from femoral access was 34% (10.8 min) faster using the VersaCross steerable system compared to the standard workflow (Figure 3B). The transseptal puncture times in our study are comparable to those seen in previous fluoroless transseptal punctures [11,15], and fluoroscopy-guided transseptal puncture [10,16] using RF wire or RF needle.…”

“…Apart from imaging advancements, tools such as the use of purpose-built RF puncture technology have been shown to result in shorter instrumentation time, greater efficacy in transseptal crossing, and fewer episodes of pericardial tamponade [10]. More recently, the RF wire system was shown to achieve completely fluoroless transseptal puncture safely and effectively while improving procedural efficiency in RF ablations [11]. Several studies have shown the benefits of a steerable sheath for RF ablations [4,[12][13][14], however, the use of steerable sheath for transseptal puncture remains uncommon.…”

Use of a novel integrated dilator-needle system in cryoballoon procedures: a zero-exchange approach

“…The transseptal sheath is then replaced by a large bore sheath. Demo et al has recently demonstrated the feasibility and efficacy of this system in CBA procedures [18]. However, it is important to realize that with the VersaCross system, you still need to exchange the standard transseptal sheath for the large bore sheath; thus, it is not a zero-exchange approach like the AcQCross system.…”

Can all stakeholders benefit from same‐day discharge following catheter ablation of atrial fibrillation?

“…special radiofrequency wires like VersaCross ® (Baylis Medical). 5 The introduction of radiofrequency catheters with force or local impedance sensors and algorithms for lesion formation assessment have led to shorter radiofrequency application times, and along with secondgeneration single-shot cryoballoon ablation systems, have led to improved safety and a decrease in ablation procedure time. In addition, performing the procedures on continuous anticoagulation has proven to be safe and has led to lower periprocedural thromboembolic events.…”

“…The adoption of ultrasound‐guided vascular access has led to a 2/3 decrease in procedural vascular complications 4 . Transseptal puncture, which many physicians consider one of the most dreaded steps of the procedure, has become safer under direct visualization guided by intracardiac echo and three‐dimensional mapping, using special radiofrequency wires like VersaCross® (Baylis Medical) 5 …”