For structural heart interventions, a radiofrequency needle achieved better crossing success and shorter procedure times for trans-septal puncture in a single-center study.
Although 12% of standard needle attempts needed the help of an assistance wire, none of the radiofrequency needle interventions required it. Furthermore, two patients whose standard needle procedures initially failed had success later on with the radiofrequency approach, according to Jason H. Rogers, MD, of University of California, Davis Medical Center, and colleagues.
The radiofrequency needle and the standard needle shared similar spatial accuracy rates and clinical outcomes, but septum tenting was less pronounced with this option (P=0.004). Trans-septal procedural times also favored the radiofrequency needle (P=0.02).
“This finding is not unexpected since the use of radiofrequency energy ablates tissue and facilitates crossing,” the authors wrote in Catheterization and Cardiovascular Interventions.
“In the hands of an experienced operator, there were no major clinically significant differences between the standard and radiofrequency needle approaches,” they acknowledged. “Both radiofrequency and standard needle trans-septal puncture are feasible and safe … There were no major complications with either trans-septal puncture strategy, and all procedures were completed successfully regardless of initial choice of trans-septal needle.”
Citing the difference in septum tenting, however, Rogers’ group made the case that “the use of a radiofrequency needle may be a safer approach” for patients with a hyper-elastic septum.
Their study included 52 patients who underwent interventions with standard or radiofrequency trans-septal access. A single operator performed all cases.
Rogers reported serving as a proctor for St. Jude Medical and being part of the speakers’ bureaus of Baylis and Abbott Vascular.
Catheterization and Cardiovascular Interventions
Sharma G, et al “Accuracy and procedural characteristics of standard needle compared with radiofrequency needle transseptal puncture for structural heart interventions” Catheter Cardiovasc Interv 2016; DOI: 10.1002/ccd.26608.