Randomized trial of conventional transseptal needle versus radiofrequency energy needle puncture for left atrial access (the TRAVERSE-LA study).

Jonathan C. Hsu, Nitish Badhwar, Edward P. Gerstenfeld, Randall J. Lee, Mala C. Mandyam, Thomas Dewland, Kourtney E. Imburgia, Kurt S. Hoffmayer, Vasanth Vedantham, Byron K. Lee, Zian H. Tseng, Melvin M. Scheinman, Jeffrey E. Olgin, Gregory M. Marcus

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Transseptal puncture is a critical step in achieving left atrial (LA) access for a variety of cardiac procedures. Although the mechanical Brockenbrough needle has historically been used for this procedure, a needle employing radiofrequency (RF) energy has more recently been approved for clinical use. We sought to investigate the comparative effectiveness of an RF versus conventional needle for transseptal LA access. In this prospective, single-blinded, controlled trial, 72 patients were randomized in a 1:1 fashion to an RF versus conventional (BRK-1) transseptal needle. In an intention-to-treat analysis, the primary outcome was time required for transseptal LA access. Secondary outcomes included failure of the assigned needle, visible plastic dilator shavings from needle introduction, and any procedural complication. The median transseptal puncture time was 68% shorter using the RF needle compared with the conventional needle (2.3 minutes [interquartile range {IQR}, 1.7 to 3.8 minutes] versus 7.3 minutes [IQR, 2.7 to 14.1 minutes], P = 0.005). Failure to achieve transseptal LA access with the assigned needle was less common using the RF versus conventional needle (0/36 [0%] versus 10/36 [27.8%], P <0.001). Plastic shavings were grossly visible after needle advancement through the dilator and sheath in 0 (0%) RF needle cases and 12 (33.3%) conventional needle cases (P <0.001). There were no differences in procedural complications (1/36 [2.8%] versus 1/36 [2.8%]). Use of an RF needle resulted in shorter time to transseptal LA access, less failure in achieving transseptal LA access, and fewer visible plastic shavings.

Original languageEnglish (US)
JournalJournal of the American Heart Association
Volume2
Issue number5
StatePublished - Oct 2013
Externally publishedYes

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Punctures
Needles
Plastics
Intention to Treat Analysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

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Randomized trial of conventional transseptal needle versus radiofrequency energy needle puncture for left atrial access (the TRAVERSE-LA study). / Hsu, Jonathan C.; Badhwar, Nitish; Gerstenfeld, Edward P.; Lee, Randall J.; Mandyam, Mala C.; Dewland, Thomas; Imburgia, Kourtney E.; Hoffmayer, Kurt S.; Vedantham, Vasanth; Lee, Byron K.; Tseng, Zian H.; Scheinman, Melvin M.; Olgin, Jeffrey E.; Marcus, Gregory M.

In: Journal of the American Heart Association, Vol. 2, No. 5, 10.2013.

Research output: Contribution to journalArticle

Hsu, JC, Badhwar, N, Gerstenfeld, EP, Lee, RJ, Mandyam, MC, Dewland, T, Imburgia, KE, Hoffmayer, KS, Vedantham, V, Lee, BK, Tseng, ZH, Scheinman, MM, Olgin, JE & Marcus, GM 2013, 'Randomized trial of conventional transseptal needle versus radiofrequency energy needle puncture for left atrial access (the TRAVERSE-LA study).', Journal of the American Heart Association, vol. 2, no. 5.
Hsu, Jonathan C. ; Badhwar, Nitish ; Gerstenfeld, Edward P. ; Lee, Randall J. ; Mandyam, Mala C. ; Dewland, Thomas ; Imburgia, Kourtney E. ; Hoffmayer, Kurt S. ; Vedantham, Vasanth ; Lee, Byron K. ; Tseng, Zian H. ; Scheinman, Melvin M. ; Olgin, Jeffrey E. ; Marcus, Gregory M. / Randomized trial of conventional transseptal needle versus radiofrequency energy needle puncture for left atrial access (the TRAVERSE-LA study). In: Journal of the American Heart Association. 2013 ; Vol. 2, No. 5.
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abstract = "Transseptal puncture is a critical step in achieving left atrial (LA) access for a variety of cardiac procedures. Although the mechanical Brockenbrough needle has historically been used for this procedure, a needle employing radiofrequency (RF) energy has more recently been approved for clinical use. We sought to investigate the comparative effectiveness of an RF versus conventional needle for transseptal LA access. In this prospective, single-blinded, controlled trial, 72 patients were randomized in a 1:1 fashion to an RF versus conventional (BRK-1) transseptal needle. In an intention-to-treat analysis, the primary outcome was time required for transseptal LA access. Secondary outcomes included failure of the assigned needle, visible plastic dilator shavings from needle introduction, and any procedural complication. The median transseptal puncture time was 68{\%} shorter using the RF needle compared with the conventional needle (2.3 minutes [interquartile range {IQR}, 1.7 to 3.8 minutes] versus 7.3 minutes [IQR, 2.7 to 14.1 minutes], P = 0.005). Failure to achieve transseptal LA access with the assigned needle was less common using the RF versus conventional needle (0/36 [0{\%}] versus 10/36 [27.8{\%}], P <0.001). Plastic shavings were grossly visible after needle advancement through the dilator and sheath in 0 (0{\%}) RF needle cases and 12 (33.3{\%}) conventional needle cases (P <0.001). There were no differences in procedural complications (1/36 [2.8{\%}] versus 1/36 [2.8{\%}]). Use of an RF needle resulted in shorter time to transseptal LA access, less failure in achieving transseptal LA access, and fewer visible plastic shavings.",
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T1 - Randomized trial of conventional transseptal needle versus radiofrequency energy needle puncture for left atrial access (the TRAVERSE-LA study).

AU - Hsu, Jonathan C.

AU - Badhwar, Nitish

AU - Gerstenfeld, Edward P.

AU - Lee, Randall J.

AU - Mandyam, Mala C.

AU - Dewland, Thomas

AU - Imburgia, Kourtney E.

AU - Hoffmayer, Kurt S.

AU - Vedantham, Vasanth

AU - Lee, Byron K.

AU - Tseng, Zian H.

AU - Scheinman, Melvin M.

AU - Olgin, Jeffrey E.

AU - Marcus, Gregory M.

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N2 - Transseptal puncture is a critical step in achieving left atrial (LA) access for a variety of cardiac procedures. Although the mechanical Brockenbrough needle has historically been used for this procedure, a needle employing radiofrequency (RF) energy has more recently been approved for clinical use. We sought to investigate the comparative effectiveness of an RF versus conventional needle for transseptal LA access. In this prospective, single-blinded, controlled trial, 72 patients were randomized in a 1:1 fashion to an RF versus conventional (BRK-1) transseptal needle. In an intention-to-treat analysis, the primary outcome was time required for transseptal LA access. Secondary outcomes included failure of the assigned needle, visible plastic dilator shavings from needle introduction, and any procedural complication. The median transseptal puncture time was 68% shorter using the RF needle compared with the conventional needle (2.3 minutes [interquartile range {IQR}, 1.7 to 3.8 minutes] versus 7.3 minutes [IQR, 2.7 to 14.1 minutes], P = 0.005). Failure to achieve transseptal LA access with the assigned needle was less common using the RF versus conventional needle (0/36 [0%] versus 10/36 [27.8%], P <0.001). Plastic shavings were grossly visible after needle advancement through the dilator and sheath in 0 (0%) RF needle cases and 12 (33.3%) conventional needle cases (P <0.001). There were no differences in procedural complications (1/36 [2.8%] versus 1/36 [2.8%]). Use of an RF needle resulted in shorter time to transseptal LA access, less failure in achieving transseptal LA access, and fewer visible plastic shavings.

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