Improved Left Atrial Appendage Occlusion Procedural Efficiency Using Radiofrequency Transseptal Wire System
Journal of the Society for Cardiovascular Angiography & Interventions
Left atrial appendage closure (LAAC) often requires multiple wire and sheath exchanges resulting in a longer left atrial (LA) dwell time thereby increasing the risk of potential complications.
LAAC using the WATCHMAN device (Boston Scientific) was performed using a standard workflow (NRG RF needle, Baylis; 8.5F SL1 sheath, Abbott; ProTrack pigtail wire, Baylis) or VC (RF pigtail wire and dedicated 8.5F sheath). Procedural characteristics were retrospectively compared between the two groups. In the VC group, the VC RF pigtail wire was used for vascular access, transseptal puncture (TSP), and often for access and sheath exchange in the LAA. The primary endpoint was procedural efficiency determined by time to final implant release. Secondary endpoints were time to TSP puncture, LAAC success, fluoroscopy use, and procedural complications.
A total of 84 consecutive patients underwent LAAC using the VCRF system (54) or standard workflow (30). Both groups had similar patient baseline characteristics. All procedures were successful and there were no complications. Time to TS between the RF wire and RF needle was not significantly different (Fig 1A). Time to final implant release was 13% lower using the VC wire (p=0.03, Fig 1B). Time to TS between the RF wire and RF needle was not significantly different (Fig 1A). There was no difference in overall fluoroscopy time (7.7 ± 2.8 vs. 9.0 ± 4.3, p=0.11); however, fluoroscopy dose was 67% lower (p=0.006; Fig 1C).
VC decreases the time to implant release by reducing the number of exchanges in the LA and better visualization of this system likely leads to a reduced fluoroscopy dose.
Whitler C, McClellan B, Patel H, Rajpurohit D, Kalaba F, Kado H, et al. [Kondur A]. Improved left atrial appendage occlusion procedural efficiency using radiofrequency transseptal wire system. J Soc Cardiovasc Angiogr Interv. 2022 May-Jun;1(3 Suppl):100254. doi:10.1016/j.jscai.2022.100254.