270 Short-term results of pulmonary vein isolation for paroxysmal atrial fibrillation using duty-cycled bipolar and unipolar radiofrequency energy: The initial Québec experience

safety and efficacy of LA access with the NRG needle but without routine echo guidance. METHODS: This is a single-center, retrospective observational study. From September 2010 to March 2011, 104 patients underwent 105 LA catheter ablation procedures using the NRG needle for TSP access. A routine strategy of 2 separate TSP accesses was performed. Transseptal access was initially performed using the NRG needle within an 8.5 French SL-1 long sheath with fluoroscopy alone and without the use of routine echo (trans-esophageal or intracardiac) guidance. Left atrial access was confirmed with LA pressure monitoring and/or contrast injection. Intravenous heparin was infused after successful TSP access. Rates of successful TSP access with the NRG needle, need for RF energy delivery for TSP access, need for echo imaging guidance, and serious intra-procedural complications (death, tamponade, pericardial access) were recorded. RESULTS: Two hundred and nine TSP procedures were attempted in 105 procedures (104 patients). A single TSP access was performed in 1 patient who had a mechanical mitral valve. 41 patients (39%) had previous LA catheter ablation procedures. Echo guidance was performed in 2 cases (2.0%) to facilitate TSP access. The rates of successful LA access using the NRG needle without echo guidance was 96% (200 of 209 attempts). Radiofrequency energy was required to facilitate LA access in 62 attempts (31%). In the remaining successful TSP punctures, manual pressure with the NRG needle alone was sufficient to cross the atrial septum. One procedure (1%) was complicated by cardiac tamponade which occurred 78 minutes after TSP access, and was managed with percutaneous drainage. No death occurred in this study. CONCLUSIONS: In this study of patients undergoing left atrial catheter ablation, a high rate of transseptal access was achieved with the NRG needle and without routine echo guidance. The rates of serious intra-procedural complications and the need for “back-up” echo guidance were low. Performance of transseptal access with the NRG needle but without routine echo guidance appears to be a feasible strategy.