Needle-free atrial transseptal access: A safe and reproducible alternative for left atrial catheterization
Background: Left atrial catheterization is a common procedure in electrophysiology labs to treat arrhythmogenic substrates on the left side of the heart. Needle transseptal puncture is the standard approach, but it can lead to complications related to device design or operator technique. To reduce t...
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Elsevier
2024-11-01
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| Series: | Heart Rhythm O2 |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666501824002964 |
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| author | Alex D. Pacheco-Bouthillier, MD Jorge Javier Miguel-González, MD Adriana González-Martínez, MD, PhD Anna G. Everding-Rodríguez, MD Silvia S. Gómez-Delgadillo, MD Ángel E. Chávez-Torres, MD Angélica Fregoso-Sánchez, MD Benigno Ferreira-Piña, MD Óscar S. Lomelí-Sánchez, MD, MSc Hugo E. Coutiño-Moreno, MD, PhD Vitelio A. Mariona-Montero, MD |
| author_facet | Alex D. Pacheco-Bouthillier, MD Jorge Javier Miguel-González, MD Adriana González-Martínez, MD, PhD Anna G. Everding-Rodríguez, MD Silvia S. Gómez-Delgadillo, MD Ángel E. Chávez-Torres, MD Angélica Fregoso-Sánchez, MD Benigno Ferreira-Piña, MD Óscar S. Lomelí-Sánchez, MD, MSc Hugo E. Coutiño-Moreno, MD, PhD Vitelio A. Mariona-Montero, MD |
| author_sort | Alex D. Pacheco-Bouthillier, MD |
| collection | DOAJ |
| description | Background: Left atrial catheterization is a common procedure in electrophysiology labs to treat arrhythmogenic substrates on the left side of the heart. Needle transseptal puncture is the standard approach, but it can lead to complications related to device design or operator technique. To reduce these complications, needle-free alternatives have been explored. Objective: This study aims to report the first multicenter application of the needle-free transseptal access (NeFTA) approach, assessing its safety and efficacy in patients undergoing electrophysiological procedures. Methods: This retrospective, observational multicenter study evaluated the safety and efficacy of the NeFTA approach in patients undergoing ablation of left arrhythmogenic substrates across 3 electrophysiology centers in Mexico. NeFTA uses only a guidewire, without a needle or sharp guidewire. The sheath, with a dilator, is guided into the fossa ovalis under fluoroscopic guidance, using anterior force and clockwise torque to allow the guidewire to puncture the septum with minimal risk. Results: The NeFTA technique was used in 366 patients. Most sheaths were deflectable, with nondeflectable sheaths in 43.4% of cases. Left atrial access via NeFTA was successful in 96.18% of cases, with pericardial effusion as the only complication (0.55% rate). Conclusion: This technique was reproducible and safe, achieving successful access on the first or second attempt in 96.18% of cases, regardless of the operator. |
| format | Article |
| id | doaj-art-ffb5333a94fa4102bc6c38d22f97c05b |
| institution | Kabale University |
| issn | 2666-5018 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Heart Rhythm O2 |
| spelling | doaj-art-ffb5333a94fa4102bc6c38d22f97c05b2024-11-22T07:39:07ZengElsevierHeart Rhythm O22666-50182024-11-01511788795Needle-free atrial transseptal access: A safe and reproducible alternative for left atrial catheterizationAlex D. Pacheco-Bouthillier, MD0Jorge Javier Miguel-González, MD1Adriana González-Martínez, MD, PhD2Anna G. Everding-Rodríguez, MD3Silvia S. Gómez-Delgadillo, MD4Ángel E. Chávez-Torres, MD5Angélica Fregoso-Sánchez, MD6Benigno Ferreira-Piña, MD7Óscar S. Lomelí-Sánchez, MD, MSc8Hugo E. Coutiño-Moreno, MD, PhD9Vitelio A. Mariona-Montero, MD10Departamento de Investigación, Instituto Cardiovascular de Mínima Invasión, Zapopan, México; Unidad de Electrofisiología, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, MéxicoDepartamento de Investigación, Instituto Cardiovascular de Mínima Invasión, Zapopan, MéxicoDepartamento de Investigación, Instituto Cardiovascular de Mínima Invasión, Zapopan, MéxicoDepartamento de Investigación, Instituto Cardiovascular de Mínima Invasión, Zapopan, MéxicoDepartamento de Investigación, Instituto Cardiovascular de Mínima Invasión, Zapopan, MéxicoDepartamento de Investigación, Instituto Cardiovascular de Mínima Invasión, Zapopan, MéxicoDepartamento de Investigación, Instituto Cardiovascular de Mínima Invasión, Zapopan, MéxicoDepartamento de Investigación, Instituto Cardiovascular de Mínima Invasión, Zapopan, MéxicoDepartamento de Investigación, Instituto Cardiovascular de Mínima Invasión, Zapopan, México; Unidad de Cardiología, Hospital Civil Fray Antonio Alcalde, Guadalajara, MexicoUnidad de Electrofisiología, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, MéxicoUnidad Médica de Alta Especialidad en Pediatría, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México; Address reprint requests and correspondence: Dr Vitelio Augusto Mariona Montero, Avenida Empresarios 150, Puerta de Hierro, 45116 Zapopan, Jalisco, Mexico.Background: Left atrial catheterization is a common procedure in electrophysiology labs to treat arrhythmogenic substrates on the left side of the heart. Needle transseptal puncture is the standard approach, but it can lead to complications related to device design or operator technique. To reduce these complications, needle-free alternatives have been explored. Objective: This study aims to report the first multicenter application of the needle-free transseptal access (NeFTA) approach, assessing its safety and efficacy in patients undergoing electrophysiological procedures. Methods: This retrospective, observational multicenter study evaluated the safety and efficacy of the NeFTA approach in patients undergoing ablation of left arrhythmogenic substrates across 3 electrophysiology centers in Mexico. NeFTA uses only a guidewire, without a needle or sharp guidewire. The sheath, with a dilator, is guided into the fossa ovalis under fluoroscopic guidance, using anterior force and clockwise torque to allow the guidewire to puncture the septum with minimal risk. Results: The NeFTA technique was used in 366 patients. Most sheaths were deflectable, with nondeflectable sheaths in 43.4% of cases. Left atrial access via NeFTA was successful in 96.18% of cases, with pericardial effusion as the only complication (0.55% rate). Conclusion: This technique was reproducible and safe, achieving successful access on the first or second attempt in 96.18% of cases, regardless of the operator.http://www.sciencedirect.com/science/article/pii/S2666501824002964Transseptal catheterizationLeft heart catheterizationAblationCardiac arrhythmiaAtrial septum |
| spellingShingle | Alex D. Pacheco-Bouthillier, MD Jorge Javier Miguel-González, MD Adriana González-Martínez, MD, PhD Anna G. Everding-Rodríguez, MD Silvia S. Gómez-Delgadillo, MD Ángel E. Chávez-Torres, MD Angélica Fregoso-Sánchez, MD Benigno Ferreira-Piña, MD Óscar S. Lomelí-Sánchez, MD, MSc Hugo E. Coutiño-Moreno, MD, PhD Vitelio A. Mariona-Montero, MD Needle-free atrial transseptal access: A safe and reproducible alternative for left atrial catheterization Heart Rhythm O2 Transseptal catheterization Left heart catheterization Ablation Cardiac arrhythmia Atrial septum |
| title | Needle-free atrial transseptal access: A safe and reproducible alternative for left atrial catheterization |
| title_full | Needle-free atrial transseptal access: A safe and reproducible alternative for left atrial catheterization |
| title_fullStr | Needle-free atrial transseptal access: A safe and reproducible alternative for left atrial catheterization |
| title_full_unstemmed | Needle-free atrial transseptal access: A safe and reproducible alternative for left atrial catheterization |
| title_short | Needle-free atrial transseptal access: A safe and reproducible alternative for left atrial catheterization |
| title_sort | needle free atrial transseptal access a safe and reproducible alternative for left atrial catheterization |
| topic | Transseptal catheterization Left heart catheterization Ablation Cardiac arrhythmia Atrial septum |
| url | http://www.sciencedirect.com/science/article/pii/S2666501824002964 |
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