RF needle technique
Four difficult single TSPs (4/949, 0.4%) were successfully performed with the RF needle technique: 2 punctures in consecutive procedures in a patient with prior surgery of atrial myxoma, 1 TSP in a patient after previous AF ablation procedure, and 1 puncture where initial ICE evaluation revealed hypertrophied IAS. In the patient after previous AF ablation procedure, the percutaneous angioplasty (PTA) balloon was used to dilate the septal puncture site which enabled left atrial access with the long sheath. This was the only case where 7 seconds of low dose fluoroscopy (2 frames per second) was used during PTA balloon positioning and inflation. There were no adverse events in patients where RF needle technique was used.