Transcatheter Electrosurgery in the Asia-Pacific: Implementation and Innovations

Transcatheter electrosurgery involves the precise application of high-frequency electrical currents to modify or perforate cardiac structures during structural heart interventions. Adoption of these techniques in the Asia-Pacific region has grown significantly alongside the expansion of structural heart programs. Techniques such as Bioprosthetic or Native Aortic Scallop Intentional Laceration to Prevent Coronary Artery Obstruction (BASILICA), Undermining Iatrogenic Coronary Obstruction With Radiofrequency Needle (UNICORN), Laceration of the Anterior Mitral Leaflet to Prevent Outflow Obstruction (LAMPOON), and Balloon Assisted Translocation of the Mitral Anterior Leaflet to Prevent Left Ventricular Outflow Obstruction (BATMAN) have been employed by regional interventionalists to lacerate native or prosthetic heart valves before transcatheter valve implantation, thereby mitigating the risks of coronary or left ventricular outflow tract obstruction. In addition, transcaval access has facilitated transcatheter aortic valve replacement in patients with limited iliofemoral vascular access. This narrative review, authored by the Asia-Pacific Electrosurgery Working Group, explores the evolution of transcatheter electrosurgery, highlighting regional adoption, variations, and innovative contributions. Furthermore, it discusses prevailing challenges and future directions, emphasizing the importance of standardized training and collaborative innovation efforts.