Wire Instrumentation Using Radiofrequency Energy to Impact Transseptal Efficiency

Study Overview
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Brief Summary
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This is a randomized controlled trial examining whether Baylis's Versacross RF wire versus the conventional Baylis RF needle is better at puncturing through a thin wall in the heart (called transseptal puncture) as measured by time to successful transseptal puncture, during cardiac ablation procedures.

Detailed Description
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The transseptal puncture is one of the most commonly performed procedures in the cardiac electrophysiology and interventional cardiology laboratories. Indeed, every atrial fibrillation ablation, now the predominant electrophysiology procedure performed throughout the world, routinely involves two different transseptal puncture procedures. The investigators previously performed a randomized, comparative effectiveness trial demonstrating the superiority (in both efficacy and safety) of a radiofrequency (RF) transseptal needle versus the conventional sharp-tipped mechanical needle. More recently, an alternative approach to transseptal puncture has been FDA approved and is already utilized as part of standard of care in these procedures. With this new approach, a J-shaped wire that can transmit RF energy is advanced inside the transeptal sheath rather than the more stiff RF or conventional needle. As advancing a wire is usually a step employed in any transseptal procedure (then usually requiring removal of that wire and then placement of the needle), this new approach saves a step. In addition once the wire has been advanced across the intra-atrial septum into the left atrium, the wire can be used to avoid potentially severe complications; specifically, after a transseptal needle is advanced across the left atrium, advancing the sheath over the needle can result in a sudden jump of all the equipment, risking perforation of the far left atrial wall. With the wire approach, the wire can be safely advanced into a pulmonary vein so that even if the sheath and dilator jump suddenly across the septum, they will be guided along the wire and thereby avoid perforation. The investigators will be studying patients undergoing a catheter ablation procedure at University of California, San Francisco.

Official Title
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Wire Instrumentation Using Radiofrequency Energy to Impact Transseptal Efficiency

Conditions
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Atrial Fibrillation, Atrial Flutter

Intervention / Treatment
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* Device: Baylis Versacross RF wire
* Device: Baylis RF needle


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age ≥ 18 years old Patients undergoing endocardial left atrial catheter ablation procedures using radiofrequency ablation catheters for atrial fibrillation or atrial flutter ablation procedures at UCSF Willing and able to provide written informed consent in English Willing and able to comply with scheduled remote follow-up visits through 1 Year post-operative Exclusion Criteria: Presence of a patent foramen ovale closure device or atrial septal defect closure device Cryoballoon ablation IVC filter Deemed not suitable by study personnel

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Baylis Versacross RF wire<br>Device: Baylis Versacross radiofrequency wire | Device: Baylis Versacross RF wire<br>* Baylis Versacross radiofrequency wire is used for transseptal puncture during cardiac ablation procedure.<br>|
| Active Comparator: Baylis RF Needle<br>Device: conventional Baylis radiofrequency needle | Device: Baylis RF needle<br>* Baylis radiofrequency needle is used for transseptal puncture during cardiac ablation procedure.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time to Achieve First Transseptal Puncture | First transseptal time was recorded for each participant, starting with insertion of the long guidewire into the femoral short sheath (J wire for RF needle group, VersaCross wire for RF wire group) and stopping once the transseptal sheath was positioned in the LA and the dilator and guidewire were fully removed from the long sheath. Median time in minutes to completion of the first transseptal puncture during the cardiac ablation procedure between the RF needle and RF Wire group was compared as the outcome. | 0-30 minutes (from insertion of guidewire to removal of guidewire of first transseptal) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time to Achieve Second Transseptal Puncture | Second transseptal time was recorded for each participant, starting with insertion of the long guidewire into the femoral short sheath (J wire for RF needle group, VersaCross wire for RF wire group) and stopping once the transseptal sheath was positioned in the LA and the dilator and guidewire were fully removed from the long sheath. The median time in minutes to completion of the second transseptal puncture during the cardiac ablation procedure between the RF needle and RF Wire group was compared as a secondary outcome. Participants that did not undergo 2 transseptal punctures were not included in this analysis. | 0-30 minutes (from insertion of guidewire to removal of guidewire of second transseptal) | 
| Combined Transseptal Time | Combined transseptal time was calculated for each participant by summing up participants' first and second transseptal times. The median combined transseptal time in minutes between the RF needle and RF Wire group was compared as a secondary outcome. Participants that did not undergo two transseptal punctures were not included in this analysis. | 0-60 minutes (summation of first transseptal and second transseptal times) | 
| Fluoroscopy Time | Fluoroscopy time (amount of time operators used fluoroscopy during a transseptal puncture) was recorded for each participant, starting with insertion of the long guidewire into the femoral short sheath (J wire for RF needle group, VersaCross wire for RF wire group) and stopping once the transseptal sheath was positioned in the LA and the dilator and guidewire were fully removed from the long sheath. Median fluoroscopy time during the first and second transseptal punctures between the RF needle and RF Wire group was compared as a secondary outcome. | 0-60 minutes (from insertion of guidewire to removal of guidewire of first transseptal and second transseptal) | 
| Number of Participants With Equipment Exchanges | An equipment exchange was defined as the removal of the J or RF wire from the dilator and sheath assembly before transseptal puncture; all RF needle punctures required at least 1 equipment exchange, although further exchanges could be performed as necessary if the initial pull-down resulted in inadequate positioning of the sheath and dilator and readvancement of the transseptal assembly into the SVC was necessary. The number of equipment exchanges during the cardiac ablation procedure between the RF need and RF wire groups were compared. | (0-8 hours) duration of cardiac ablation procedure | 
| Complication Rates | The number of participants with complications during the procedure between the RF needle and RF wire groups was compared as a secondary outcome. | complications were assessed during the duration of cardiac ablation procedure (up to 8 hours) |