Guidewire electrosurgery-assisted trans-septal puncture

Area of Science:

• Cardiovascular Interventions
• Structural Heart Disease
• Electrophysiology

Background:

• Trans-septal puncture is crucial for structural interventions.
• Dedicated radiofrequency devices are costly; direct needle use may pose safety risks.
• A novel technique using an electrified coronary guidewire addresses these limitations.

Purpose of the Study:

• To evaluate the safety and efficacy of electrifying a coronary guidewire as an escalation strategy for trans-septal access.
• To overcome limitations of existing trans-septal puncture methods.

Main Methods:

• A coronary guidewire connected to an electrosurgery pencil was advanced through the trans-septal sheath.
• Radiofrequency energy was applied briefly to perforate the interatrial septum.
• Post-hoc validation involved microscopic comparison of electrified needle vs. guidewire punctures in explanted pig hearts.

Main Results:

• The guidewire electrosurgery technique was successfully used in eight patients with challenging atrial septa (thickened or surgically repaired).
• No procedure-related complications occurred.
• Microscopic analysis showed smaller puncture sizes and blanched penumbra with the electrified guidewire compared to an electrified needle.

Conclusions:

• Electrifying a coronary guidewire is a safe and effective method for achieving trans-septal access when conventional techniques fail.
• This technique is inexpensive and readily accessible to clinicians.
• It provides a viable alternative for patients requiring structural interventions.