Radiofrequency-Assisted Transseptal Access for Atrial Fibrillation Ablation Via a Superior Approach

Jackson J. Liang, Aung Lin, Sanghamitra Mohanty, Daniele Muser, David F. Briceno, J. David Burkhardt, Gregory E. Supple, David J. Callans, Sanjay Dixit, Rodney P. Horton, Luigi Di Biase, Francis E. Marchlinski, Andrea Natale, Pasquale Santangeli

Research output: Contribution to journalArticle

Abstract

Objectives: This study describes the technique and outcomes of atrial fibrillation (AF) ablation via a superior approach in patients with interrupted or absent inferior vena cavas (IVCs). Background: In patients with interrupted or absent IVCs, transseptal access cannot be obtained via standard femoral venous access. In these patients, alternative strategies are necessary to permit catheter ablation in the left atrium (LA). This study reports on the outcomes of AF ablation from a superior venous access with a radiofrequency (RF)-assisted transseptal puncture (TSP) technique. Methods: This study identified patients with interrupted or absent IVCs who underwent AF ablation via a superior approach at 2 ablation centers from 2010 to 2019. Results: Fifteen patients (mean age: 50.8 ± 11.2 years; 10 men; 10 with paroxysmal AF) with interrupted or absent IVCs underwent AF ablation with transseptal access via a superior approach. Successful TSP was performed either with a manually bent RF transseptal needle (early cases: n = 4) or using a RF wire (late cases: n = 11); this approach permitted LA mapping and ablation in all patients. Mean time required to perform single (n = 8) or double (n = 7) TSP was 16.1 ± 4.8 min, and mean total procedure time was 227.9 ± 120.7 min (fluoroscopy time: 57.0 ± 28.5 min). LA mapping and ablation were successfully performed in all patients. Conclusions: In patients with AF undergoing catheter ablation and who had a standard transseptal approach via femoral venous approach is impossible due to anatomic constraints, RF-assisted transseptal access via a superior approach can be an effective alternative strategy to permit LA mapping and ablation.

Original languageEnglish (US)
Pages (from-to)272-281
Number of pages10
JournalJACC: Clinical Electrophysiology
Volume6
Issue number3
DOIs
StatePublished - Mar 2020

Keywords

  • atrial fibrillation
  • axillary
  • catheter ablation
  • inferior vena cava
  • jugular
  • subclavian
  • superior

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Fingerprint Dive into the research topics of 'Radiofrequency-Assisted Transseptal Access for Atrial Fibrillation Ablation Via a Superior Approach'. Together they form a unique fingerprint.

  • Cite this

    Liang, J. J., Lin, A., Mohanty, S., Muser, D., Briceno, D. F., Burkhardt, J. D., Supple, G. E., Callans, D. J., Dixit, S., Horton, R. P., Di Biase, L., Marchlinski, F. E., Natale, A., & Santangeli, P. (2020). Radiofrequency-Assisted Transseptal Access for Atrial Fibrillation Ablation Via a Superior Approach. JACC: Clinical Electrophysiology, 6(3), 272-281. https://doi.org/10.1016/j.jacep.2019.10.019