The RF transseptal puncture system
This new technique for transseptal catheterization, which utilizes Radiofrequency energy rather than mechanical energy.
The RF transseptal puncture system has several safety features.
The external diameter of the Radiofrequency element is 0.016@ and is smaller than the standard Brockenbrough needle (0.30–0.40@).
The transseptal puncture catheter is floppy and incapable of imparting any mechanical deviation of the septum. When advanced against the septum in an RF off-mode, it reflects into a coiled configuration within the right atrium.
The RF energy and timing (2–5 sec) levels used, there is little or no chance of left atrial free wall puncture by the RF catheter itself.
The transition between the transseptal catheter and the sheath and dilator system is gradual and, by the current experience, not prone to the overshoot phenomenon.
As with the Brockenbrough needle system, structures adjacent to the septum, such as right atrial free wall, vena cavae, tricuspid apparatus, and great vessels, are vulnerable to perforation with the RF catheter system.
Utilization of the intracardiac echocardiography to guide placement of the transseptal perforation catheter to its optimal position prior to advancement and activation of RF energy is recommended. Electrocardiographic readings can also be obtained through the RF tip in order to locate the ideal perforation position. This technique has shown to provide useful information regarding the location of the electrode and using limited amounts of fluoroscopy time.
The Radiofrequency transseptal puncture catheter is an important advance in the field of diagnostic and interventional cardiology.