Radiofrequency Needle and Conventional Mechanical Needle for Transseptal Access: A Systematic Review and Meta-Analysis.

BACKGROUND

Transseptal puncture (TSP) is essential for various structural and electrophysiological cardiac procedures. However, the conventional mechanical needle can be challenging in complex anatomies. Radiofrequency (RF)-assisted puncture systems offer an alternative to facilitate septal crossing and potentially reduce complications. This study aimed to evaluate the efficacy and safety of RF needle TSP compared with the conventional mechanical approach.

MATERIALS AND

METHODS

A systematic review and meta-analysis was conducted following PRISMA guidelines (PROSPERO: CRD420251272470). Primary efficacy outcomes included unassisted success, crossover, and TSP and fluoroscopy time, failure to obtain left atrial access, while safety outcomes included pericardial effusion or cardiac tamponade. Statistical analyses were conducted in R software (version 4.5.1) risk ratios (RR) and differences (MD), and heterogeneity was assessed by I2 statistics.

RESULTS

This review included nine studies, amongst them randomized and nonrandomized. The RF needle demonstrated statistically significant superiority in several efficacy outcomes: increased unassisted success (RR: 1.05; 95% CI: 1.01-1.10), marked reduction risk in crossover rate (RR: 0.11; 95% CI: 0.03-0.38), and failure to obtain transseptal access (RR: 0.11; 95% CI: 0.04-0.33). Furthermore, the RF technique significantly reduced TSP time (MD: -154.7 s) and fluoroscopy time (MD: -84.5 s). Successful TSP rates (RR: 1.03; 95% CI: 0.99-1.06) and pericardial effusion or cardiac tamponade (RR: 0.55; 95% CI: 0.12-2.57) were comparable between groups.

CONCLUSION

RF-assisted TSP demonstrated superior performance compared with the conventional mechanical technique, offering higher unassisted primary efficacy, reducing access failures, and improving procedural efficiency. Although major complication rates are similar, RF may be considered a preferred strategy, especially in complex anatomies, due to its predictability and potential benefit in neurological safety.