Improved left atrial appendage closure procedural efficiency using radiofrequency transseptal wire system

Abstract

Objective The radiofrequency (RF) needle has been shown to improve transseptal puncture efficiency and safety compared to mechanical needles. This study aimed to investigate the use of VersaCross RF transseptal wire system (Baylis Medical) to improve procedural efficiency of left atrial appendage closure (LAAC) compared to the standard RF needle‐based workflow. Methods Eighty‐one LAAC procedures using WATCHMAN FLX were retrospectively analyzed comparing the standard RF needle‐based workflow to a RF wire‐based workflow. Study primary endpoint was time to WATCHMAN device release, and secondary endpoints were transseptal puncture time, LAAC success, fluoroscopy use, and procedural complications. Results Twenty‐five cases using standard RF needle‐based workflow were compared to 56 cases using the RF wire‐based workflow. Baseline patient characteristics were similar between both groups. LAAC was successful in all patients with no differences in intraprocedural complication rates (p = 0.40). Transseptal puncture time was 1.3 min faster using the RF wire‐based workflow compared to the standard RF needle‐based workflow (6.5 ± 2.3 vs. 7.8 ± 2.3 min, p = 0.02). Overall, time to final WATCHMAN device release was 4.5 min faster with the RF wire‐based workflow compared to the RF needle‐based workflow (24.6 ± 5.6 vs. 29.1 ± 9.6 min, p = 0.01). Fluoroscopy time was 21% lower using the RF wire‐based workflow (7.6 ± 2.8 vs. 9.6 ± 4.4 min; p = 0.05) and fluoroscopy dose was 67% lower (47.1 ± 35.3 vs. 144.9 ± 156.9 mGy, p = 0.04) and more consistent (F‐test, p ˂ 0.0001). Conclusions The RF wire‐based workflow streamlines LAAC procedures, improving LAAC efficiency and safety by reducing fluoroscopy, device exchanges, and delivery sheath manipulation.

Novel streamlined technique for left atrial appendage closure using a radiofrequency wire‐based large access system

“…The use of the VLA system is consistent with a previous study showing easier crossing of septum, without resistance or excessive tenting, using a seamless sheath‐dilator device to facilitate large delivery sheath, such as the WATCHMAN delivery sheath 12 . Previously, Whitler et al have shown that the RF‐wire based workflow can streamline LAAC procedures, improving procedure efficiency and safety by reducing fluoroscopy, device exchanges, and delivery sheath manipulation 15 . Similarly, in our study the additional benefit of the RF‐wire based approach was the optimized and direct access to the LAA, likely accounting for the overall procedural efficiency.…”

“…shown that the RF-wire based workflow can streamline LAAC procedures, improving procedure efficiency and safety by reducing fluoroscopy, device exchanges, and delivery sheath manipulation. 15 Similarly, in our study the additional benefit of the RF-wire based approach was the optimized and direct access to the LAA, likely accounting for the overall procedural efficiency. operators in this study have significant experience with WATCH-MAN FLX LAAC; therefore, it is not known whether the results of this study would translate to less experienced operators.…”