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Guidewire electrosurgery‐assisted trans‐septal puncture
Author(s) -
Khan Jaffar M.,
Rogers Toby,
Eng Marvin H.,
Lederman Robert J.,
Greenbaum Adam B.
Publication year - 2018
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.27311
Subject(s) - medicine , dilator , electrosurgery , interatrial septum , surgery , nasal septum , radiology , cardiology , left atrium , atrial fibrillation , nose
Objectives Electrifying a coronary guidewire may be a simple escalation strategy when trans‐septal needle puncture is unsuccessful. Background Radiofrequency energy to facilitate trans‐septal puncture through a dedicated device is costly and directly through a trans‐septal needle may be less safe. Our technique overcomes these limitations. Methods The technique was used in patients when trans‐septal needle penetration failed despite excessive force or tenting of the atrial septum. A coronary guidewire, connected to an electrosurgery pencil, was advanced through the trans‐septal needle, dilator, and sheath to perforate the interatrial septum during a short burst of radiofrequency energy. With the guidewire tip no longer “active,” the dilator and sheath were advanced safely over the wire into the left atrium. In posthoc validation, radiofrequency assisted Brockenbrough needle and coronary guidewire punctures were made in freshly explanted pig hearts and compared under microscopy. Results Eight patients who required trans‐septal access for structural intervention were escalated to a guidewire electrosurgery strategy. Six patients had thickened fibrotic septum and two had prior surgical patch repair. Crossing was successful in all patients with no procedure related complications. The size of punctures (1.11 ± 0.40 mm vs 0.37 ± 0.08 mm, P = .009) and blanched penumbra (3.62 ± 1.23 mm vs 0.72 ± 0.29 mm, P = .003) in pig atrial septum were larger with an electrified needle than electrified guidewire. The hole generated by the electrified guidewire was smaller than by the nonelectrified needle. Conclusions When conventional trans‐septal puncture fails, a coronary guidewire can be used to deliver brief radiofrequency energy safely and effectively. This technique is inexpensive and accessible to operators.