Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, Zhejiang, P. R. China.
Department of Cardiology, The Second Hospital of Anhui Medical University, HeFei, Anhui, P. R. China.
Pacing Clin Electrophysiol. 2024 Mar;47(3):448-454. doi: 10.1111/pace.14916. Epub 2024 Jan 30.
Application of electrocautery to a J-wire is used to perform transseptal puncture (TSP), but with limited evidence supporting safety and efficacy. We conducted a prospective randomized controlled trial to evaluate the safety and efficacy of this technique.
Two hundred consecutive patients were randomized in a 1:1 fashion to either the ICE-guided electrified J-wire TSP group or a conventional Brockenbrough (BRK) needle TSP group. The TSP was performed with a 0.032″ guidewire under 20 W, "coag" mode and was compared to TSP using the BRK needle. The primary safety endpoints were complications related to TSP. The primary efficacy endpoints included the TSP success rate, the total TSP time, and the total procedure time.
All patients complete the procedure safely. The electrified J-wire TSP group had a significantly shorter TSP time than BRK needle TSP group. The total procedure time, number of TSP attempts required to achieve successful LA access, width of the intra-atrial shunt at the end of ablation were similar between the two groups. The incidence of new cerebral infarction detected by MRI were similar between the two groups (3/32 patients in the J-wire TSP group and 2/26 patients in conventional BRK TSP group, p = .82). And no difference in the incidence of residual intra-atrial shunt (4.3% vs. 6%, p = .654) during the 3-month's follow up.
Using an electrified J-wire for TSP under the guidance of ICE appears to be as safe as and more efficient than conventional BRK needle TSP, which may be especially useful in the era of non-fluoroscopy AF ablation.
电灼 J 型导丝用于行经房间隔穿刺（TSP），但安全性和有效性的证据有限。我们进行了一项前瞻性随机对照试验，以评估该技术的安全性和有效性。
将 200 例连续患者以 1:1 的比例随机分为 ICE 引导的电灼 J 型导丝 TSP 组或传统的 Brockenbrough（BRK）针 TSP 组。在 20 W、“凝血”模式下使用 0.032″导丝进行 TSP，并与使用 BRK 针进行的 TSP 进行比较。主要安全性终点是与 TSP 相关的并发症。主要疗效终点包括 TSP 成功率、总 TSP 时间和总手术时间。
所有患者均安全完成手术。电灼 J 型导丝 TSP 组的 TSP 时间明显短于 BRK 针 TSP 组。两组的总手术时间、实现 LA 入路成功所需的 TSP 尝试次数、消融结束时的房间隔分流宽度相似。两组 MRI 检测到的新发脑梗死发生率相似（电灼 J 型导丝 TSP 组 3/32 例，传统 BRK 针 TSP 组 2/26 例，p=0.82）。在 3 个月的随访期间，残余房间隔分流的发生率也无差异（4.3% vs. 6%，p=0.654）。
在 ICE 引导下使用电灼 J 型导丝进行 TSP 似乎与传统的 BRK 针 TSP 一样安全且更有效，这在无透视 AF 消融时代可能特别有用。
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