The use of a radiofrequency needle improves the safety and efficacy of transseptal puncture for atrial fibrillation ablation.

BACKGROUND: Atrial fibrillation (AF) ablation requires transseptal puncture to gain entry to the left atrium (LA). On rare occasions, LA entry cannot be achieved or cardiac perforation results in pericardial tamponade.
OBJECTIVE: This study sought to compare a new radiofrequency (RF) transseptal needle with the standard needle.
METHODS: We evaluated 1,550 AF ablations in 1,167 patients. We compared 975 transseptal punctures done using a standard needle to 575 done using a new electrode-tipped needle attached to an RF perforation generator.
RESULTS: The rate of failure to cross the atrial septum was lower for the RF needle (1 of 575 [0.17%] vs. 12 of 975 [1.23%], P = .039) and there were fewer pericardial tamponades with the RF needle (0 of 575 [0.00%] vs. 9 of 975 [0.92%], P = .031). Multivariate analysis showed the RF needle use was the only variable associated with a lower incidence of tamponade (P = .04). Becasuse the RF needle was used later in our series, we examined our 975 standard needle punctures over time for evidence of improved operator experience that might explain the superior RF results. For the standard needle, there was no trend for improved septal crossing rates (P = .794) or fewer tamponades (P = .456) with more operator experience. Instrumentation time was shorter for the RF needle (27.1 ± 10.9 vs. 36.4 ± 17.7 minutes, P < .0001).
CONCLUSION: Our data suggest that the RF needle is superior to the standard transseptal needle. It results in shorter instrumentation times, a greater efficacy in transseptal crossing, and fewer episodes of pericardial tamponade.