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Bradley P. Knight - One of the best experts on this subject based on the ideXlab platform.
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incidence of tissue coring during Transseptal catheterization when using electrocautery and a standard Transseptal Needle
Circulation-arrhythmia and Electrophysiology, 2012Co-Authors: Eugene Greenstein, Albert C. Lin, Rod S. Passman, Bradley P. KnightAbstract:Background— The application of radiofrequency electrocautery to a standard, open-ended Transseptal Needle has been used to facilitate Transseptal puncture (TSP). The purpose of this study was to determine the incidence of cardiac tissue coring when this technique is used. Methods and Results— A model using excised swine hearts submerged in a saline-filled basin was developed to simulate TSP with electrocautery and a standard Transseptal Needle. Punctures were performed without the use of electrocautery and by delivering radiofrequency energy to the Transseptal Needle using a standard electrocautery pen at 3 target sites (fossa ovalis, non–fossa ovalis septum, and aorta). The tissue of the submerged heart was gently tented, and the Needle was advanced on delivery of radiofrequency. The devices were retracted, and the Needle was flushed in a collection basin. None of the TSPs without cautery caused tissue coring. For TSPs using electrocautery, the frequency of coring was at least 21% for any puncture permutation used in the study and averaged 37% at septal sites ( P <0.001 compared with punctures without cautery). Tissue coring occurred in 33 of 96 (35%) punctures through the fossa ovalis and in 38 of 96 (40%) punctures through non–fossa ovalis septum. The frequency of tissue coring at aortic sites was 62 of 96 (65%), which was significantly higher than at the septal sites ( P <0.001). Conclusions— In an animal preparation, TSP at the level of the fossa ovalis using electrocautery and a standard open-ended Brockenbrough Needle resulted in coring of the septal tissue in 35% of cases (33 of 96 punctures).
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Incidence of Tissue Coring During Transseptal Catheterization When Using Electrocautery and a Standard Transseptal Needle
Circulation-arrhythmia and Electrophysiology, 2012Co-Authors: Eugene Greenstein, Albert C. Lin, Rod S. Passman, Bradley P. KnightAbstract:Background— The application of radiofrequency electrocautery to a standard, open-ended Transseptal Needle has been used to facilitate Transseptal puncture (TSP). The purpose of this study was to determine the incidence of cardiac tissue coring when this technique is used. Methods and Results— A model using excised swine hearts submerged in a saline-filled basin was developed to simulate TSP with electrocautery and a standard Transseptal Needle. Punctures were performed without the use of electrocautery and by delivering radiofrequency energy to the Transseptal Needle using a standard electrocautery pen at 3 target sites (fossa ovalis, non–fossa ovalis septum, and aorta). The tissue of the submerged heart was gently tented, and the Needle was advanced on delivery of radiofrequency. The devices were retracted, and the Needle was flushed in a collection basin. None of the TSPs without cautery caused tissue coring. For TSPs using electrocautery, the frequency of coring was at least 21% for any puncture permutation used in the study and averaged 37% at septal sites ( P
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Transseptal catheterization using a powered radiofrequency Transseptal Needle
Journal of Interventional Cardiac Electrophysiology, 2010Co-Authors: Dipak P. Shah, Bradley P. KnightAbstract:Mechanical pressure applied to a Brockenbrough Needle at the fossa ovalis is the standard Transseptal puncture technique. Circumstances where the fossa ovalis is thick or aneurysmal can make this method challenging. In this case, we illustrate the use of a radiofrequency powered Transseptal Needle to cross the fossa ovalis.
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Initial Experience Using a Radiofrequency Powered Transseptal Needle
Journal of Cardiovascular Electrophysiology, 2009Co-Authors: Matthew P. Smelley, Dipak P. Shah, Ian Weisberg, Susan S. Kim, Albert C. Lin, John F. Beshai, C D O Martin Burke, Bradley P. KnightAbstract:Introduction: The purpose of this study was to determine the safety and efficacy of using a novel radiofrequency (RF) powered Transseptal Needle to perform Transseptal puncture (TSP). Methods: TSP was performed in 35 consecutive patients undergoing left-sided catheter ablation (mean age = 51 years; male = 71%) using a RF powered Transseptal Needle (NRG, Adult Large and Standard Curve C1, 71 cm, Baylis Medical Company, Inc.). Prior TSP had been performed in 34% of patients. The Transseptal apparatus was positioned with the tip of the dilator engaged in the fossa ovalis. RF energy was delivered to the tip of the Transseptal Needle using a proprietary RF generator at 10 W for 2 seconds as gentle pressure was applied to the Needle. Results: In 5 of the 41 TSPs, the Needle crossed into the left atrium before RF energy was delivered. In 35 of the remaining 36 punctures, the Needle was successfully advanced into the left atrium after application of RF current. In 1 patient, the TSP with the powered Needle was unsuccessful but was accomplished using a standard Needle. The only complication was a transient right atrial thrombus, which occurred in 2 patients. Conclusion: A radiofrequency powered Transseptal Needle can be used to perform TSP safely and successfully without the need for significant mechanical force, even in patients who have undergone TSP previously. Additional studies are needed to determine whether a powered Transseptal Needle should be used routinely. (J Cardiovasc Electrophysiol, Vol. 21, pp. 423–427, April 2010)
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Double Transseptal catheterization guided by real-time 3-dimensional transesophageal echocardiography
Heart Rhythm, 2007Co-Authors: Kiam Khiang Lim, Lissa Sugeng, Roberto M. Lang, Bradley P. KnightAbstract:547-5271/$ -see front matter © 2008 Heart Rhythm Society. All rights reserved sophagus to the level of the left atrium (LA). Three 8F ransvenous sheaths were introduced into the right femoral ein. A quadripolar electrophysiology catheter was advanced hrough a sheath and positioned in the coronary sinus, and n ablation catheter was advanced through a long guiding heath (SRO, St. Jude Medical, St Paul, MN) to the right trium (RA). Transseptal puncture was performed using a Transseptal heath and dilator (SL1, St. Jude Medical) and a standard rockenbrough Transseptal Needle. The dilator was withrawn from the superior vena cava and manipulated to ause tenting of the intra-atrial septum at level of the fossa valis (FO) as imaged with RT3D-TEE (Figure 1). The eedle was advanced to puncture the septum during continFigure 2 FO fossa ovalis; LA left atrium; RA right atrium.
Byron K. Lee - One of the best experts on this subject based on the ideXlab platform.
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Randomized trial of conventional Transseptal Needle versus radiofrequency energy Needle puncture for left atrial access (the TRAVERSE-LA study)
Journal of the American Heart Association, 2013Co-Authors: Jonathan C. Hsu, Nitish Badhwar, Edward P. Gerstenfeld, Randall J. Lee, Mala C. Mandyam, Thomas A. Dewland, Kourtney E. Imburgia, Kurt S. Hoffmayer, Vasanth Vedantham, Byron K. LeeAbstract:Background Transseptal puncture is a critical step in achieving left atrial (LA) access for a variety of cardiac procedures. Although the mechanical Brockenbrough Needle has historically been used for this procedure, a Needle employing radiofrequency (RF) energy has more recently been approved for clinical use. We sought to investigate the comparative effectiveness of an RF versus conventional Needle for Transseptal LA access. Methods and Results In this prospective, single-blinded, controlled trial, 72 patients were randomized in a 1:1 fashion to an RF versus conventional (BRK-1) Transseptal Needle. In an intention-to-treat analysis, the primary outcome was time required for Transseptal LA access. Secondary outcomes included failure of the assigned Needle, visible plastic dilator shavings from Needle introduction, and any procedural complication. The median Transseptal puncture time was 68% shorter using the RF Needle compared with the conventional Needle (2.3 minutes [interquartile range {IQR}, 1.7 to 3.8 minutes] versus 7.3 minutes [IQR, 2.7 to 14.1 minutes], P =0.005). Failure to achieve Transseptal LA access with the assigned Needle was less common using the RF versus conventional Needle (0/36 [0%] versus 10/36 [27.8%], P
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randomized trial of conventional Transseptal Needle versus radiofrequency energy Needle puncture for left atrial access the traverse la study
Journal of the American Heart Association, 2013Co-Authors: Jonathan C. Hsu, Nitish Badhwar, Edward P. Gerstenfeld, Randall J. Lee, Mala C. Mandyam, Thomas A. Dewland, Kourtney E. Imburgia, Kurt S. Hoffmayer, Vasanth Vedantham, Byron K. LeeAbstract:Background Transseptal puncture is a critical step in achieving left atrial (LA) access for a variety of cardiac procedures. Although the mechanical Brockenbrough Needle has historically been used for this procedure, a Needle employing radiofrequency (RF) energy has more recently been approved for clinical use. We sought to investigate the comparative effectiveness of an RF versus conventional Needle for Transseptal LA access. Methods and Results In this prospective, single-blinded, controlled trial, 72 patients were randomized in a 1:1 fashion to an RF versus conventional (BRK-1) Transseptal Needle. In an intention-to-treat analysis, the primary outcome was time required for Transseptal LA access. Secondary outcomes included failure of the assigned Needle, visible plastic dilator shavings from Needle introduction, and any procedural complication. The median Transseptal puncture time was 68% shorter using the RF Needle compared with the conventional Needle (2.3 minutes [interquartile range {IQR}, 1.7 to 3.8 minutes] versus 7.3 minutes [IQR, 2.7 to 14.1 minutes], P =0.005). Failure to achieve Transseptal LA access with the assigned Needle was less common using the RF versus conventional Needle (0/36 [0%] versus 10/36 [27.8%], P <0.001). Plastic shavings were grossly visible after Needle advancement through the dilator and sheath in 0 (0%) RF Needle cases and 12 (33.3%) conventional Needle cases ( P <0.001). There were no differences in procedural complications (1/36 [2.8%] versus 1/36 [2.8%]). Conclusions Use of an RF Needle resulted in shorter time to Transseptal LA access, less failure in achieving Transseptal LA access, and fewer visible plastic shavings. Clinical Trial Registration URL: . Unique identifier: [NCT01209260][1]. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT01209260&atom=%2Fahaoa%2F2%2F5%2Fe000428.atom
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Repeat Transseptal Catheterization After Ablation for Atrial Fibrillation
Journal of Cardiovascular Electrophysiology, 2006Co-Authors: Gregory M. Marcus, Nitish Badhwar, Randall J. Lee, Byron K. Lee, Xiushui Ren, Zian H. Tseng, Elyse Foster, Jeffrey E. OlginAbstract:Introduction: A substantial number of patients require a second left atrial procedure after ablation for atrial fibrillation (AF), either for left atrial flutter or recurrent AF. The success and complication rates of repeat Transseptal catheterization in these patients are unknown. The aim of this study was to determine the difficulty and/or success rates of repeat Transseptal catheterization after left atrial ablation for AF. Methods and Results: Consecutive patients undergoing repeat left atrial procedures after ablation for AF over a 1-year period were enrolled. Difficulties with, success rates, and complications of the first and second Transseptal catheterizations were recorded. Sixteen patients underwent a repeat Transseptal catheterization. Of the 4 in whom the first procedure was performed with an ablation catheter across a patent foramen ovale (PFO), 3 required a Transseptal puncture for their repeat procedure. The remaining 12 underwent Transseptal puncture without difficulty for their first procedure, and, despite the same operators for each patient, the repeat Transseptal was noted to be difficult in 5. Of those 5, the Transseptal puncture was unsuccessful due to increased interatrial septal thickness in 2 patients. One repeat Transseptal attempt was aborted after posterior right atrial puncture with the Transseptal Needle occurred, attributed to distorted interatrial septal anatomy not observed prior to the first case. Conclusions: Compared with the first procedure, repeat Transseptal catheterization after ablation for AF, whether initially performed across a PFO or via a Transseptal puncture, is more difficult, less often successful, and potentially associated with more complications.
Narayanswami Sreeram - One of the best experts on this subject based on the ideXlab platform.
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Transhepatic approach for catheter interventions in infants and children with congenital heart disease
Clinical Research in Cardiology, 2006Co-Authors: Narayanswami SreeramAbstract:We report on our experience with transhepatic access for catheter interventions in six children (age range 2.5 months–9 years). Three had systemic venous anomalies, and one infant a femoral venous occlusion. In two further patients with bradyarrhythmia after a Fontan operation with an intraatrial Gore–Tex^® tunnel, transhepatic access was chosen to achieve a perpendicular orientation of the Transseptal Needle to the atrial baffle, allowing puncture of the Gore–Tex^® membrane. Two of the patients underwent ablation of an accessory pathway; in one an atrial septal defect was closed. A 2.5 month old baby after Norwood I operation, underwent balloon dilation of the pulmonary arteries. Two patients after prior Fontan surgery underwent DDDR pacemaker implantation. The size of the introducer sheath ranged from 4 F up to two 9 F introducers in the same vein for pacemaker insertion. At the end of the procedure, hemostasis was achieved by external compression. Results Transhepatic access could be established in all six patients (using a mirror image approach in children with left atrial isomerism) and the interventional procedures could be performed as planned. In one patient with implantation of a permanent pacemaker, a subcutaneous hematoma occurred, requiring blood transfusion. Conclusion In selected pediatric patients, transhepatic access for catheter intervention can easily be achieved.
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Transhepatic approach for catheter interventions in infants and children with congenital heart disease.
Clinical Research in Cardiology, 2006Co-Authors: Narayanswami SreeramAbstract:We report on our experience with transhepatic access for catheter interventions in six children (age range 2.5 months–9 years). Three had systemic venous anomalies, and one infant a femoral venous occlusion. In two further patients with bradyarrhythmia after a Fontan operation with an intraatrial Gore–Tex® tunnel, transhepatic access was chosen to achieve a perpendicular orientation of the Transseptal Needle to the atrial baffle, allowing puncture of the Gore–Tex® membrane. Two of the patients underwent ablation of an accessory pathway; in one an atrial septal defect was closed. A 2.5 month old baby after Norwood I operation, underwent balloon dilation of the pulmonary arteries. Two patients after prior Fontan surgery underwent DDDR pacemaker implantation. The size of the introducer sheath ranged from 4 F up to two 9 F introducers in the same vein for pacemaker insertion. At the end of the procedure, hemostasis was achieved by external compression.
Jonathan C. Hsu - One of the best experts on this subject based on the ideXlab platform.
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Randomized trial of conventional Transseptal Needle versus radiofrequency energy Needle puncture for left atrial access (the TRAVERSE-LA study)
Journal of the American Heart Association, 2013Co-Authors: Jonathan C. Hsu, Nitish Badhwar, Edward P. Gerstenfeld, Randall J. Lee, Mala C. Mandyam, Thomas A. Dewland, Kourtney E. Imburgia, Kurt S. Hoffmayer, Vasanth Vedantham, Byron K. LeeAbstract:Background Transseptal puncture is a critical step in achieving left atrial (LA) access for a variety of cardiac procedures. Although the mechanical Brockenbrough Needle has historically been used for this procedure, a Needle employing radiofrequency (RF) energy has more recently been approved for clinical use. We sought to investigate the comparative effectiveness of an RF versus conventional Needle for Transseptal LA access. Methods and Results In this prospective, single-blinded, controlled trial, 72 patients were randomized in a 1:1 fashion to an RF versus conventional (BRK-1) Transseptal Needle. In an intention-to-treat analysis, the primary outcome was time required for Transseptal LA access. Secondary outcomes included failure of the assigned Needle, visible plastic dilator shavings from Needle introduction, and any procedural complication. The median Transseptal puncture time was 68% shorter using the RF Needle compared with the conventional Needle (2.3 minutes [interquartile range {IQR}, 1.7 to 3.8 minutes] versus 7.3 minutes [IQR, 2.7 to 14.1 minutes], P =0.005). Failure to achieve Transseptal LA access with the assigned Needle was less common using the RF versus conventional Needle (0/36 [0%] versus 10/36 [27.8%], P
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randomized trial of conventional Transseptal Needle versus radiofrequency energy Needle puncture for left atrial access the traverse la study
Journal of the American Heart Association, 2013Co-Authors: Jonathan C. Hsu, Nitish Badhwar, Edward P. Gerstenfeld, Randall J. Lee, Mala C. Mandyam, Thomas A. Dewland, Kourtney E. Imburgia, Kurt S. Hoffmayer, Vasanth Vedantham, Byron K. LeeAbstract:Background Transseptal puncture is a critical step in achieving left atrial (LA) access for a variety of cardiac procedures. Although the mechanical Brockenbrough Needle has historically been used for this procedure, a Needle employing radiofrequency (RF) energy has more recently been approved for clinical use. We sought to investigate the comparative effectiveness of an RF versus conventional Needle for Transseptal LA access. Methods and Results In this prospective, single-blinded, controlled trial, 72 patients were randomized in a 1:1 fashion to an RF versus conventional (BRK-1) Transseptal Needle. In an intention-to-treat analysis, the primary outcome was time required for Transseptal LA access. Secondary outcomes included failure of the assigned Needle, visible plastic dilator shavings from Needle introduction, and any procedural complication. The median Transseptal puncture time was 68% shorter using the RF Needle compared with the conventional Needle (2.3 minutes [interquartile range {IQR}, 1.7 to 3.8 minutes] versus 7.3 minutes [IQR, 2.7 to 14.1 minutes], P =0.005). Failure to achieve Transseptal LA access with the assigned Needle was less common using the RF versus conventional Needle (0/36 [0%] versus 10/36 [27.8%], P <0.001). Plastic shavings were grossly visible after Needle advancement through the dilator and sheath in 0 (0%) RF Needle cases and 12 (33.3%) conventional Needle cases ( P <0.001). There were no differences in procedural complications (1/36 [2.8%] versus 1/36 [2.8%]). Conclusions Use of an RF Needle resulted in shorter time to Transseptal LA access, less failure in achieving Transseptal LA access, and fewer visible plastic shavings. Clinical Trial Registration URL: . Unique identifier: [NCT01209260][1]. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT01209260&atom=%2Fahaoa%2F2%2F5%2Fe000428.atom
Haulon Stéphan - One of the best experts on this subject based on the ideXlab platform.
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Transcatheter transcaval embolization of a type II endoleak after EVAR using a Transseptal Needle-sheath system
2012Co-Authors: Midulla Marco, Perini Paolo, Sundareyan Ramanivas, Lazguet Younes, Dehaene Aurelie, Goyault Gilles, Martinelli Thomas, Haulon StéphanAbstract:Purpose. The purpose of this study is to present an alternative technique for management of a type II endoleak associated with aneurysm sac enlargement. Technique. We report the use of a Transseptal Needle-sheath system for a transcatheter transcaval embolization (TTE) in a 3-staged treatment of a persistent type II endoleak after abdominal EVAR. Inferior vena cava is cannulated through a femoral venous access, and aneurysmal sac access is gained with a puncture through the walls of the 2 vessels at the site where the vein is adjacent to the aneurysm. The whole system (sheath-dilator-Needle) is then advanced across the vascular walls into the aortic sac. Thus, embolization with glue is performed. Conclusion. The TTE using a Transseptal Needle-sheath system demonstrated to be feasible and effective to treat a persistent type II endoleak after failure of 2 attempts of transarterial embolization of the feeding vessels. © The Author(s) 2012
