Efficacy and efficiency of left atrial access is improved by radiofrequency transseptal puncture during pulsed field ablation procedures

Abstract Background Purpose-built radiofrequency needles (RFN) have been found to improve transseptal puncture (TSP) efficiency and safety compared to standard mechanical needles (MN). Additionally, pulsed field ablation (PFA) has proven to be an effective and efficient modality for treating atrial fibrillation compared to thermal ablation. However, little is known about the combined use of RFN and PFA dedicated sheath in terms of efficacy and efficiency. Purpose To compare how mechanical and radiofrequency needles impact real-world, fluoroscopy-only, PFA procedures. Methods A single-center, retrospective review of consecutive, fluoroscopy-only PFA cases using a pentaspline catheter was conducted. Procedures followed the same workflow, with the only variable being the type of TSP needle used (MN or RFN) directly through the PFA dedicated sheath. Operators used only one type of TSP needle, which was determined by their standard of care. There were no operator-dependent differences, and all patients were included in the final analysis. Efficacy and efficiency were evaluated based on TSP success, procedural time points, and the occurrence of severe adverse events prior to discharge. Results A total of 182 cases were reviewed, where 48.3% (88) were performed using MN-based TSP and 51.6% (94) were performed using RFN-based TSP. There were no differences in baseline characteristics between groups (Table). The MN workflow had significantly lower TSP success rates compared to the RF needle workflow (MN: 95.5%, RFN: 100%, p=0.037). This difference was due to 1 (1.1%) MN case resulting in cardiac tamponade and 3 (3.4%) MN cases requiring a switch to RF needles. Importantly, RFN workflows were associated with more efficient and consistent TSP times (MN: 12.1±3.1 mins, RFN: 10.7±2.5 mins, p=0.001; Figure) when compared to MN workflows. Despite significantly more PFA applications being delivered in the cases where the RFN was used, there were no differences in overall procedure or fluoroscopy times between the two groups (Figure). Conclusions Radiofrequency TSP devices enhance the efficacy and efficiency of left atrial access, which provides predictability in the workflow for all patient anatomies. Improved consistency and reliability offered by radiofrequency TSP devices may further result in enhanced patient quality of life and electrophysiology lab efficiency. Figure 1