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BioMed Research International
Volume 2017, Article ID 2351925, 5 pages
https://doi.org/10.1155/2017/2351925
Clinical Study

Modified Transseptal Puncture Technique in Challenging Septa: A Randomized Comparison to Conventional Technique

1Department of Cardiology, St Jan Hospital Bruges, Ruddershove 10, 8000 Bruges, Belgium
2University Hospital of Ghent, Ghent, Belgium

Correspondence should be addressed to Mattias Duytschaever; eb.najtnisza@reveahcstyud.saittam

Received 13 September 2016; Revised 27 November 2016; Accepted 20 December 2016; Published 30 January 2017

Academic Editor: Christof Kolb

Copyright © 2017 Vikas Kataria et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Transseptal puncture (TSP) can be challenging. We compared safety and efficacy of a modified TSP technique (“mosquito” technique, MOSQ-TSP) to conventional TSP (CONV-TSP). Method. Patients undergoing AF ablation in whom first attempt of TSP did not result in left atrial (LA) pressure (failure to cross, FTC) were randomized to MOSQ-TSP (i.e., puncture of the fossa via a wafer-thin inner stylet) or CONV-TSP (i.e., additional punctures at different positions). Primary endpoint was LA access. Secondary endpoints were safety, time, fluoroscopic dose (dose-area product, DAP), and number of additional punctures from FTC to final LA access. Result. Of 384 patients, 68 had FTC (MOSQ-TSP, versus CONV-TSP, ). No complications were reported. In MOSQ-TSP, primary endpoint was 100% (versus 73.5%, ), median time to LA access was 72 s [from 37 to 384 s] (versus 326 s [from 75 s to 1936 s], ), mean DAP to LA access was mGy/cm2 (versus mGy/cm2, ), and median number of additional punctures was 2 [1 to 3] (versus 0, ). Conclusion. In AF patients in whom the first attempt of TSP fails, the “mosquito” technique allows effective, safe, and time sparing LA access. This approach might facilitate TSP in elastic, aneurysmatic, or fibrosed septa.