Randomized trial of conventional versus radiofrequency needle transseptal puncture for cryoballoon ablation: the CRYO-LATS trial

Jason G. Andrade, Laurent Macle, Matthew T. Bennett, Nathaniel M. Hawkins, Vidal Essebag, Jean Champagne, Jean Francois Roux, Bhavanesh Makanjee, Anthony Tang, Allan Skanes, Yaariv Khaykin, Carlos Morillo, Umjeet Jolly, Evan Lockwood, Guy Amit, Paul Angaran, John Sapp, Stephan Wardell, George A. Wells, Atul VermaMarc W. Deyell

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

Background: Transseptal puncture to achieve left atrial access is necessary for many cardiac procedures, including atrial fibrillation ablation. More recently, there has been an increasing need for left atrial access using large caliber sheaths, which increases risk of perforation associated with the initial advancement into the left atrium. We compared the effectiveness of a radiofrequency needle-based transseptal system versus conventional needle for transseptal access. Methods: This prospective controlled trial randomized 161 patients with symptomatic paroxysmal atrial fibrillation undergoing cryoballoon pulmonary vein isolation to transseptal access with a commercially available transseptal system (radiofrequency needle plus stiff pigtail wire; RF + Pigtail group) versus conventional transseptal access (standard group). The primary outcome was time required for left atrial access. Secondary outcomes included failure of the assigned transseptal system, radiation exposure, and complications. Results: The median transseptal puncture time was significantly shorter using the radiofrequency needle plus stiff pigtail wire transseptal system compared with conventional transseptal (840 ± 323 vs. 956 ± 407 s, P = 0.0489). Compared to conventional transseptal puncture, fewer transseptal attempts were required (1.0 ± 0.5 RF applications vs. 1.3 ± 0.8 mechanical punctures, P = 0.0123) and the fluoroscopy time was significantly shorter (72.0 [IQR 48.0, 129.0] vs. 93.0 [IQR 60.0, 171.0] s, P = 0.0490) with the radiofrequency needle plus stiff pigtail wire transseptal system. Failure to achieve transseptal LA access with the assigned system was rarely observed (1.3% vs. 5.7%, P = 0.2192). There were no procedural complications observed with either system. Conclusions: The use of a radiofrequency needle plus stiff pigtail wire resulted in shorter time to left atrial access and reduced fluoroscopy time compared to left atrial access using conventional transseptal equipment. Trial registration: ClinicalTrials.gov identifier NCT03199703.

Original languageEnglish
Pages (from-to)481-489
Number of pages9
JournalJournal of Interventional Cardiac Electrophysiology
Volume65
Issue number2
DOIs
StatePublished - 1 Nov 2022
Externally publishedYes

Keywords

  • Catheter ablation
  • Radiofrequency
  • Transseptal puncture

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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