Background: Catheter ablation for atrial fibrillation (AF) typically involves transseptal puncture (TSP) to access the left atrium. Traditional TSP requires sheath upsizing and exchanges, increasing procedural complexity, time, and risks. We evaluated the efficiency and safety of zero-exchange technique using the FlexCath Advance™ sheath combined with the VersaCross™ RF wire compared to the traditional method involving initial puncture with Agilis™ NxT sheath and Baylis RF needle, followed by sheath exchange.
Methods: This retrospective observational study included 109 patients undergoing their first cryoballoon AF ablation between June 2023 to June 2024 at Marshfield Medical Center. Procedural efficiency (time from venous access to TSP, time to first ablation, total procedural time), safety outcomes (pericardial effusion, bleeding, stroke/TIA, phrenic nerve injury, esophageal injury), and fluoroscopy exposure were compared between zero-exchange (n = 50) and traditional (n = 59) groups. Linear regression analyses were adjusted for age, sex, BMI, left ventricular ejection fraction (LVEF), and open-heart surgery history.
Results: The zero-exchange approach significantly improved procedural efficiency, with shorter time from venous access to TSP (20 ± 9 vs. 28 ± 12 min; p < 0.01), time to first ablation (36 ± 9 vs. 48 ± 16 min; p < 0.01), and total procedure duration (107 ± 31 vs. 129 ± 51 min; p < 0.01). Adjusted regression analyses confirmed these reductions (all p < 0.01). Fluoroscopy time was substantially lower with zero-exchange (8.4 ± 4 min vs. 19.9 ± 8.2 min; p < 0.01). No significant complications occurred in either group.
Conclusion: The zero-exchange transseptal puncture technique using FlexCath Advance™ and VersaCross™ RF wire significantly enhances procedural efficiency and reduces radiation exposure without compromising patient safety, supporting its adoption in AF ablation procedures.
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