Assessing the Feasibility of Radiofrequency Wire-Based Transseptal Puncture in Fluoroscopy-Only Pulsed Field Ablation...

Area of Science:

• Cardiovascular Interventions
• Electrophysiology
• Medical Device Technology

Background:

• Left atrial (LA) access is crucial for catheter ablation.
• Radiofrequency wire (RFW)-based transseptal puncture (TSP) offers advantages over mechanical needle (MN) techniques.
• European adoption of RFW-TSP is limited by concerns over costly adjunctive imaging.

Purpose of the Study:

• To evaluate the feasibility of RFW-based TSP in fluoroscopy-only pulsed field ablation (PFA) procedures.
• To compare the safety, efficacy, and efficiency of RFW-TSP versus MN-TSP.
• To determine if RFW-TSP can be utilized without expensive additional imaging.

Main Methods:

• Retrospective chart review of 617 consecutive PFA cases.
• TSP performed using either MN or RFW, with MN as benchmark.
• All procedures used fluoroscopy as the primary imaging modality.

Main Results:

• LA access was successful in all RFW cases (435 procedures).
• No significant difference in complication rates between RFW and MN groups.
• RFW group had no need for adjunctive echocardiography (0%) vs. 1.6% in MN group (p<0.01).
• RFW demonstrated faster and more consistent access in patients with prior TSP.

Conclusions:

• RFW systems are safe and effective for fluoroscopy-only PFA workflows.
• RFW-TSP offers efficiency and predictability comparable to MN-based devices.
• The benefits of RFW-TSP can be achieved without costly imaging modalities.