Sunday, May 18, 2008

Best Trick from the HRS Meeting

For all the electrophysiologists out there, the best trick for crossing the interatrial septum that is resistant to transseptal puncture came from the group in Pessac Bordeaux, France.

Although rare, these authors found that 6 of 280 (2%) of transseptal crossings were difficult. They proposed a simple solution: After they ensured accurate positioning of the transseptal sheath and needle on the interactrial septum, they applied unipolar radiofrequency electrocautery energy at 20W (using it's "cut" setting) to the needle within the sheath and advanced the needle slightly against the septum to cross. The contact was achieved outside the patient at the proximal end of the needle with the energy transmitted to its tip. RF energy was effective at perforating the septum in all 6 patient's in 4 +/- 4 seconds and no complications occurred.



Reference: A Straightforward Solution for Interatrial Septae Resistant to Transseptal Punctures. Knecht S, Matsuo S, Wright M, et al. Hopital cardiologique du Haut L'Eveque, Pessac Bordeaux, France. Poster PO5-41, Heart Rhythm VolL 5, Issue 5S, May 2008.


Anonymous said...

Dr. Wes,
I agree this is a great trick. It was presented at ACC 2007 by Dr. Patrick Tchou from The Cleveland Clinic in a video poster format. At at that point he had done over 200 transseptals punctures using this technique.

Anonymous said...

is there any reason to think it would be preferable to standard transseptal technique?
is there any reason to think the healing process would be different (maybe preferable)? we have encountered frequent difficulty in patients who have had multiple transseptals over the years.

Anonymous said...

I agree, cool low budget trick. Also, a small series was published recently in Heart Rhythm Dec 2007 by Shivkumar at UCLA. Nice discussion as well about ? some potential concerns. They used 45 W "cutting" setting with Blend 1 feature on, successfully in 5 pts. I believe slightly different settings was used in the larger Clev Clinic series. Also this all contrasts to more expensive Baylis "Toronto Transeptal Catheter"

DrWes said...

Anony 6:37 -
Thanks for the hattip to Dr. Tchou.

Anony 6:51 -
We have no data - seems this is best reserved for difficult transseptals. I really don't know about healing of the transseptal puncture after RF vs needle puncture alone, but one thing is clear, re-do transseptals can be harder than the original, suggesting that the needle-puncture only technique generally heals well - maybe leaving some tough scar, too.

Anony 8:58 - Thanks for the additional reference to others with similar experiences.

Anonymous said...

Thank you for your blog. It is a great resource.

Anony 6:37 -