Why the study?
In CB2 ablation, LA access typically requires exchange of a standard sheath for a 15Fr cryoballoon delivery sheath over a long wire, so researchers evaluated directly advancing the delivery sheath over the trans-septal needle under TEE guidance.
Does the over-the-needle technique using the cryoballoon delivery sheath improve procedural time and maintain safety compared to the standard over-the-wire exchange technique in patients undergoing atrial fibrillation ablation?
Does the over-the-needle technique using the cryoballoon delivery sheath improve procedural time and maintain safety compared to the standard over-the-wire exchange technique in patients undergoing atrial fibrillation ablation?
The over-the-needle technique for trans-septal access using the cryoballoon delivery sheath is feasible, safe, and significantly reduces procedural time compared to the standard over-the-wire exchange technique.
May shorten transseptal access time in cryoballoon AF ablation without excess risk; hypothesis-generating and requires randomized confirmation.
BACKGROUND: In the setting of second-generation cryoballoon (CB2) ablation, left atrial (LA) access is generally achieved using a standard sheath (SS) that is exchanged for the 15Fr cryoballoon delivery sheath (CBS) and dilator over a long wire (CBS over-the-wire technique, CBS-W). Our objective was to evaluate the direct use of the CBS to gain LA access, by advancing the latter over the trans-septal needle (CBS over-the-needle technique, CBS-N), under transesophageal echocardiographic (TEE) guidance. METHODS: Consecutive patients who underwent CB2 ablation with the CBS-N technique were evaluated for feasibility of gaining LA access using TEE guidance and fluoroscopy views. Complications related to the LA access were compared with a matched CBS-W control group. Subanalysis (30 CBS-W vs 30 CBS-N patients) evaluated time-to-LA of the CBS: time from superior vena cava (with SS vs CBS) to LA insertion of the CBS, after exchange or directly, respectively. RESULTS: LA access could be achieved in all 505 patients of the CBS-N group, without technique modification or additional equipment. Challenging interatrial septa were noted in 13% of these patients: previous atrial septal defect repair (1%), hypermobile (10%), aneurysmal (1%), and abnormally thickened/fibrotic (1%). Incidence of complications was similar to the CBS-W group. Subanalysis showed a shorter time-to-LA in the CBS-N versus CBS-W group, 72 ± 46 seconds versus 293 ± 180 seconds, P < .001. CONCLUSIONS: Our study showed that the CBS-N technique is feasible and safe under echocardiographic guidance. Without sheath exchange, it simplifies the CB2 procedure, is less costly, time sparing, and might reduce the risk of air embolism.
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Ströker et al. (2019) studied this question.
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