February 22, 2022Journal of Interventional Cardiac ElectrophysiologyOpen Access

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

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Why the study?

Despite efforts to reduce radiation exposure, concerns remain regarding the safety and added procedure time of fluoroless left-sided catheter ablations.

Does a radiofrequency transseptal wire allow for safe and effective completely fluoroless transseptal puncture and ablation in patients with left-sided cardiac arrhythmias?

Structured PICO

Does a radiofrequency transseptal wire allow for safe and effective completely fluoroless transseptal puncture and ablation in patients with left-sided cardiac arrhythmias?

Population

126 patients undergoing catheter ablation for left-sided cardiac arrhythmias (72 radiofrequency ablation, 54 cryoballoon ablation), mean age 67.6, 51% male, treated at two US centers.

Intervention

Completely fluoroless transseptal puncture and catheter ablation using a radiofrequency (RF) transseptal wire guided by 3-dimensional electroanatomic mapping (EAM) and intracardiac echocardiography (ICE).

Outcome

Procedural success (transseptal access time, procedure time) and safety (intraprocedural complications) without fluoroscopy use.safety

The use of a radiofrequency transseptal wire enables safe, efficient, and completely fluoroless transseptal puncture for left-sided catheter ablations, eliminating radiation exposure for patients and staff.

Limitations

Retrospective design
Not a comparative study
Performed in two centers with extensive prior experience in fully fluoroless protocols
Additional studies needed using operators with different levels of experience

Implication

Supports feasibility of fluoroless transseptal access; hypothesis-generating and should not yet change practice.

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.