Novel streamlined technique for left atrial appendage closure using a radiofrequency wire‐based large access system
Introduction Transseptal puncture (TSP) to allow for large delivery sheath left atrial (LA) access remains a challenging aspect of LA appendage closure (LAAC) in patients with prior history of TSP, thick or lipomatous septum, atrial septal aneurysms, or other complex cardiac anatomies. This study in...
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| Veröffentlicht in: | Journal of cardiovascular electrophysiology 2023-08, Vol.34 (8), p.1690-1697 |
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| container_title | Journal of cardiovascular electrophysiology |
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| creator | Asfour, Issa K. Elchouemi, Mohanad Gianni, Carola Helmy, Rami Tschopp, David R. Horton, Rodney P. Natale, Andrea Al‐Ahmad, Amin |
| description | Introduction
Transseptal puncture (TSP) to allow for large delivery sheath left atrial (LA) access remains a challenging aspect of LA appendage closure (LAAC) in patients with prior history of TSP, thick or lipomatous septum, atrial septal aneurysms, or other complex cardiac anatomies. This study investigates the use of the VersaCross large access (VLA) system (Baylis Medical/Boston Scientific) to improve procedural efficiency of LAAC compared to the standard needle workflow.
Methods and Results
Fifty LAAC procedures using WATCHMAN FLX between November 2021 and September 2022 were retrospectively analyzed comparing the VLA workflow (n = 25) to the standard needle workflow (n = 25). Study primary endpoint was time to procedural efficiency, and secondary endpoints included TSP time, acute LAAC success, fluoroscopy use, device recaptures, and periprocedural complications. Acute LAAC was successfully completed in all cases with no intraprocedural complications. TSP time was faster, but not significant, using the VLA workflow compared to the standard RF needle workflow (2.6 ± 1.1 min vs. 3.0 ± 1.8 min, p = 0.38). Time to WATCHMAN sheath in LA from TSP was 27% faster (1.5 ± 0.8 min vs. 2.1 ± 0.9 min; p = 0.03), and time to WATCHMAN release from TSP was 19% faster (10.5. ± 2.5 min vs. 13.0 ± 3.7 min; p = 0.01) with the VLA workflow. Overall procedure time was 15% faster (30.4 ± 5.1 min vs. 36.0 ± 6.6 min; p = 0.003) using VLA. Fluoroscopy time was 25% lower (4.0 ± 2.2 min vs. 5.5 ± 2.3 min; p = 0.003) and fluoroscopy dose was 60% lower (97.0 ± 91.7 mGy vs. 241.8 ± 240.6 mGy; p = 0.01) and more consistent [F‐test, p ˂ 0.0001] using the VLA workflow compared to the needle workflow.
Conclusion
The VLA system streamlines LAAC procedures, improving LAAC efficiency and reducing fluoroscopy use by allowing for de novo dilation of the septum for large‐bore delivery sheaths, and reducing device exchanges and delivery sheath manipulation. |
| doi_str_mv | 10.1111/jce.15995 |
| format | Article |
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Transseptal puncture (TSP) to allow for large delivery sheath left atrial (LA) access remains a challenging aspect of LA appendage closure (LAAC) in patients with prior history of TSP, thick or lipomatous septum, atrial septal aneurysms, or other complex cardiac anatomies. This study investigates the use of the VersaCross large access (VLA) system (Baylis Medical/Boston Scientific) to improve procedural efficiency of LAAC compared to the standard needle workflow.
Methods and Results
Fifty LAAC procedures using WATCHMAN FLX between November 2021 and September 2022 were retrospectively analyzed comparing the VLA workflow (n = 25) to the standard needle workflow (n = 25). Study primary endpoint was time to procedural efficiency, and secondary endpoints included TSP time, acute LAAC success, fluoroscopy use, device recaptures, and periprocedural complications. Acute LAAC was successfully completed in all cases with no intraprocedural complications. TSP time was faster, but not significant, using the VLA workflow compared to the standard RF needle workflow (2.6 ± 1.1 min vs. 3.0 ± 1.8 min, p = 0.38). Time to WATCHMAN sheath in LA from TSP was 27% faster (1.5 ± 0.8 min vs. 2.1 ± 0.9 min; p = 0.03), and time to WATCHMAN release from TSP was 19% faster (10.5. ± 2.5 min vs. 13.0 ± 3.7 min; p = 0.01) with the VLA workflow. Overall procedure time was 15% faster (30.4 ± 5.1 min vs. 36.0 ± 6.6 min; p = 0.003) using VLA. Fluoroscopy time was 25% lower (4.0 ± 2.2 min vs. 5.5 ± 2.3 min; p = 0.003) and fluoroscopy dose was 60% lower (97.0 ± 91.7 mGy vs. 241.8 ± 240.6 mGy; p = 0.01) and more consistent [F‐test, p ˂ 0.0001] using the VLA workflow compared to the needle workflow.
Conclusion
The VLA system streamlines LAAC procedures, improving LAAC efficiency and reducing fluoroscopy use by allowing for de novo dilation of the septum for large‐bore delivery sheaths, and reducing device exchanges and delivery sheath manipulation.</description><identifier>ISSN: 1045-3873</identifier><identifier>EISSN: 1540-8167</identifier><identifier>DOI: 10.1111/jce.15995</identifier><identifier>PMID: 37417961</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Atrial Appendage - diagnostic imaging ; Atrial Appendage - surgery ; atrial fibrillation ; Atrial Fibrillation - diagnostic imaging ; Atrial Fibrillation - surgery ; Cardiac Catheterization ; Efficiency ; Fluoroscopy ; Heart Atria ; Humans ; large access ; left atrial appendage ; radiofrequency wire ; Retrospective Studies ; Septum ; Sheaths ; Stroke ; transseptal puncture ; Treatment Outcome</subject><ispartof>Journal of cardiovascular electrophysiology, 2023-08, Vol.34 (8), p.1690-1697</ispartof><rights>2023 The Authors. published by Wiley Periodicals LLC.</rights><rights>2023 The Authors. Journal of Cardiovascular Electrophysiology published by Wiley Periodicals LLC.</rights><rights>2023. This article is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3485-95be592994305611f816ba35361ef2c4ccb4af1ac4b107aecee7c1b44ae71e0d3</cites><orcidid>0000-0002-8547-025X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjce.15995$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjce.15995$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37417961$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Asfour, Issa K.</creatorcontrib><creatorcontrib>Elchouemi, Mohanad</creatorcontrib><creatorcontrib>Gianni, Carola</creatorcontrib><creatorcontrib>Helmy, Rami</creatorcontrib><creatorcontrib>Tschopp, David R.</creatorcontrib><creatorcontrib>Horton, Rodney P.</creatorcontrib><creatorcontrib>Natale, Andrea</creatorcontrib><creatorcontrib>Al‐Ahmad, Amin</creatorcontrib><title>Novel streamlined technique for left atrial appendage closure using a radiofrequency wire‐based large access system</title><title>Journal of cardiovascular electrophysiology</title><addtitle>J Cardiovasc Electrophysiol</addtitle><description>Introduction
Transseptal puncture (TSP) to allow for large delivery sheath left atrial (LA) access remains a challenging aspect of LA appendage closure (LAAC) in patients with prior history of TSP, thick or lipomatous septum, atrial septal aneurysms, or other complex cardiac anatomies. This study investigates the use of the VersaCross large access (VLA) system (Baylis Medical/Boston Scientific) to improve procedural efficiency of LAAC compared to the standard needle workflow.
Methods and Results
Fifty LAAC procedures using WATCHMAN FLX between November 2021 and September 2022 were retrospectively analyzed comparing the VLA workflow (n = 25) to the standard needle workflow (n = 25). Study primary endpoint was time to procedural efficiency, and secondary endpoints included TSP time, acute LAAC success, fluoroscopy use, device recaptures, and periprocedural complications. Acute LAAC was successfully completed in all cases with no intraprocedural complications. TSP time was faster, but not significant, using the VLA workflow compared to the standard RF needle workflow (2.6 ± 1.1 min vs. 3.0 ± 1.8 min, p = 0.38). Time to WATCHMAN sheath in LA from TSP was 27% faster (1.5 ± 0.8 min vs. 2.1 ± 0.9 min; p = 0.03), and time to WATCHMAN release from TSP was 19% faster (10.5. ± 2.5 min vs. 13.0 ± 3.7 min; p = 0.01) with the VLA workflow. Overall procedure time was 15% faster (30.4 ± 5.1 min vs. 36.0 ± 6.6 min; p = 0.003) using VLA. Fluoroscopy time was 25% lower (4.0 ± 2.2 min vs. 5.5 ± 2.3 min; p = 0.003) and fluoroscopy dose was 60% lower (97.0 ± 91.7 mGy vs. 241.8 ± 240.6 mGy; p = 0.01) and more consistent [F‐test, p ˂ 0.0001] using the VLA workflow compared to the needle workflow.
Conclusion
The VLA system streamlines LAAC procedures, improving LAAC efficiency and reducing fluoroscopy use by allowing for de novo dilation of the septum for large‐bore delivery sheaths, and reducing device exchanges and delivery sheath manipulation.</description><subject>Atrial Appendage - diagnostic imaging</subject><subject>Atrial Appendage - surgery</subject><subject>atrial fibrillation</subject><subject>Atrial Fibrillation - diagnostic imaging</subject><subject>Atrial Fibrillation - surgery</subject><subject>Cardiac Catheterization</subject><subject>Efficiency</subject><subject>Fluoroscopy</subject><subject>Heart Atria</subject><subject>Humans</subject><subject>large access</subject><subject>left atrial appendage</subject><subject>radiofrequency wire</subject><subject>Retrospective Studies</subject><subject>Septum</subject><subject>Sheaths</subject><subject>Stroke</subject><subject>transseptal puncture</subject><subject>Treatment Outcome</subject><issn>1045-3873</issn><issn>1540-8167</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>EIF</sourceid><recordid>eNp1kUtO5DAQhq0RiEcPi7kAssQGFgE7fiVL1OIpNLNh1lHFqYBbTtLYCah3HGHOyEkwNMwCidq4Fl99qvJPyC_Ojnmqk4XFY67KUv0gO1xJlhVcm43UM6kyURixTXZjXDDGhWZqi2wLI7kpNd8h0-_hET2NY0DovOuxoSPa-949TEjbIVCP7UhhDA48heUS-wbukFo_xCkgnaLr7yjQAI0b2oBpqrcr-uQCvjz_qyEmn4eQJsBajJHGVRyx-0k2W_AR9z7eGfl7fnY7v8xu_lxczU9vMitkobJS1ajKvCylYEpz3qa7ahBKaI5tbqW1tYSWg5U1ZwbQIhrLaykBDUfWiBk5XHuXYUirxbHqXLToPfQ4TLHKC6Fyo3WhE3rwBV0MU-jTdomSRuelSvSMHK0pG4YYA7bVMrgOwqrirHrLokpZVO9ZJHb_wzjVHTb_yc_PT8DJGnhyHlffm6rr-dla-QpPR5Wq</recordid><startdate>202308</startdate><enddate>202308</enddate><creator>Asfour, Issa K.</creator><creator>Elchouemi, Mohanad</creator><creator>Gianni, Carola</creator><creator>Helmy, Rami</creator><creator>Tschopp, David R.</creator><creator>Horton, Rodney P.</creator><creator>Natale, Andrea</creator><creator>Al‐Ahmad, Amin</creator><general>Wiley Subscription Services, Inc</general><scope>24P</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-8547-025X</orcidid></search><sort><creationdate>202308</creationdate><title>Novel streamlined technique for left atrial appendage closure using a radiofrequency wire‐based large access system</title><author>Asfour, Issa K. ; Elchouemi, Mohanad ; Gianni, Carola ; Helmy, Rami ; Tschopp, David R. ; Horton, Rodney P. ; Natale, Andrea ; Al‐Ahmad, Amin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3485-95be592994305611f816ba35361ef2c4ccb4af1ac4b107aecee7c1b44ae71e0d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Atrial Appendage - diagnostic imaging</topic><topic>Atrial Appendage - surgery</topic><topic>atrial fibrillation</topic><topic>Atrial Fibrillation - diagnostic imaging</topic><topic>Atrial Fibrillation - surgery</topic><topic>Cardiac Catheterization</topic><topic>Efficiency</topic><topic>Fluoroscopy</topic><topic>Heart Atria</topic><topic>Humans</topic><topic>large access</topic><topic>left atrial appendage</topic><topic>radiofrequency wire</topic><topic>Retrospective Studies</topic><topic>Septum</topic><topic>Sheaths</topic><topic>Stroke</topic><topic>transseptal puncture</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Asfour, Issa K.</creatorcontrib><creatorcontrib>Elchouemi, Mohanad</creatorcontrib><creatorcontrib>Gianni, Carola</creatorcontrib><creatorcontrib>Helmy, Rami</creatorcontrib><creatorcontrib>Tschopp, David R.</creatorcontrib><creatorcontrib>Horton, Rodney P.</creatorcontrib><creatorcontrib>Natale, Andrea</creatorcontrib><creatorcontrib>Al‐Ahmad, Amin</creatorcontrib><collection>Wiley Online Library Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of cardiovascular electrophysiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Asfour, Issa K.</au><au>Elchouemi, Mohanad</au><au>Gianni, Carola</au><au>Helmy, Rami</au><au>Tschopp, David R.</au><au>Horton, Rodney P.</au><au>Natale, Andrea</au><au>Al‐Ahmad, Amin</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Novel streamlined technique for left atrial appendage closure using a radiofrequency wire‐based large access system</atitle><jtitle>Journal of cardiovascular electrophysiology</jtitle><addtitle>J Cardiovasc Electrophysiol</addtitle><date>2023-08</date><risdate>2023</risdate><volume>34</volume><issue>8</issue><spage>1690</spage><epage>1697</epage><pages>1690-1697</pages><issn>1045-3873</issn><eissn>1540-8167</eissn><abstract>Introduction
Transseptal puncture (TSP) to allow for large delivery sheath left atrial (LA) access remains a challenging aspect of LA appendage closure (LAAC) in patients with prior history of TSP, thick or lipomatous septum, atrial septal aneurysms, or other complex cardiac anatomies. This study investigates the use of the VersaCross large access (VLA) system (Baylis Medical/Boston Scientific) to improve procedural efficiency of LAAC compared to the standard needle workflow.
Methods and Results
Fifty LAAC procedures using WATCHMAN FLX between November 2021 and September 2022 were retrospectively analyzed comparing the VLA workflow (n = 25) to the standard needle workflow (n = 25). Study primary endpoint was time to procedural efficiency, and secondary endpoints included TSP time, acute LAAC success, fluoroscopy use, device recaptures, and periprocedural complications. Acute LAAC was successfully completed in all cases with no intraprocedural complications. TSP time was faster, but not significant, using the VLA workflow compared to the standard RF needle workflow (2.6 ± 1.1 min vs. 3.0 ± 1.8 min, p = 0.38). Time to WATCHMAN sheath in LA from TSP was 27% faster (1.5 ± 0.8 min vs. 2.1 ± 0.9 min; p = 0.03), and time to WATCHMAN release from TSP was 19% faster (10.5. ± 2.5 min vs. 13.0 ± 3.7 min; p = 0.01) with the VLA workflow. Overall procedure time was 15% faster (30.4 ± 5.1 min vs. 36.0 ± 6.6 min; p = 0.003) using VLA. Fluoroscopy time was 25% lower (4.0 ± 2.2 min vs. 5.5 ± 2.3 min; p = 0.003) and fluoroscopy dose was 60% lower (97.0 ± 91.7 mGy vs. 241.8 ± 240.6 mGy; p = 0.01) and more consistent [F‐test, p ˂ 0.0001] using the VLA workflow compared to the needle workflow.
Conclusion
The VLA system streamlines LAAC procedures, improving LAAC efficiency and reducing fluoroscopy use by allowing for de novo dilation of the septum for large‐bore delivery sheaths, and reducing device exchanges and delivery sheath manipulation.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>37417961</pmid><doi>10.1111/jce.15995</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-8547-025X</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Atrial Appendage - diagnostic imaging Atrial Appendage - surgery atrial fibrillation Atrial Fibrillation - diagnostic imaging Atrial Fibrillation - surgery Cardiac Catheterization Efficiency Fluoroscopy Heart Atria Humans large access left atrial appendage radiofrequency wire Retrospective Studies Septum Sheaths Stroke transseptal puncture Treatment Outcome |
| title | Novel streamlined technique for left atrial appendage closure using a radiofrequency wire‐based large access system |
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