{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T16:30:27Z","timestamp":1782577827544,"version":"3.54.5"},"reference-count":14,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2019,5,13]],"date-time":"2019-05-13T00:00:00Z","timestamp":1557705600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pacing Clinical Electrophis"],"published-print":{"date-parts":[[2019,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>In the setting of second\u2010generation cryoballoon (CB2) ablation, left atrial (LA) access is generally achieved using a standard sheath (SS) that is exchanged for the 15Fr cryoballoon delivery sheath (CBS) and dilator over a long wire (CBS over\u2010the\u2010wire technique, CBS\u2010W). Our objective was to evaluate the direct use of the CBS to gain LA access, by advancing the latter over the trans\u2010septal needle (CBS over\u2010the\u2010needle technique, CBS\u2010N), under transesophageal echocardiographic (TEE) guidance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Consecutive patients who underwent CB2 ablation with the CBS\u2010N technique were evaluated for feasibility of gaining LA access using TEE guidance and fluoroscopy views. Complications related to the LA access were compared with a matched CBS\u2010W control group. Subanalysis (30 CBS\u2010W vs 30 CBS\u2010N patients) evaluated time\u2010to\u2010LA of the CBS: time from superior vena cava (with SS vs CBS) to LA insertion of the CBS, after exchange or directly, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>LA access could be achieved in all 505 patients of the CBS\u2010N group, without technique modification or additional equipment. Challenging interatrial septa were noted in 13% of these patients: previous atrial septal defect repair (1%), hypermobile (10%), aneurysmal (1%), and abnormally thickened\/fibrotic (1%). Incidence of complications was similar to the CBS\u2010W group. Subanalysis showed a shorter time\u2010to\u2010LA in the CBS\u2010N versus CBS\u2010W group, 72\u00a0\u00b1\u00a046 seconds versus 293\u00a0\u00b1\u00a0180 seconds, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our study showed that the CBS\u2010N technique is feasible and safe under echocardiographic guidance. Without sheath exchange, it simplifies the CB2 procedure, is less costly, time sparing, and might reduce the risk of air embolism.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pace.13709","type":"journal-article","created":{"date-parts":[[2019,5,1]],"date-time":"2019-05-01T02:06:07Z","timestamp":1556676367000},"page":"868-873","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Over\u2010the\u2010needle trans\u2010septal access using the cryoballoon delivery sheath and dilator in atrial fibrillation ablation"],"prefix":"10.1111","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9094-2576","authenticated-orcid":false,"given":"Erwin","family":"Str\u00f6ker","sequence":"first","affiliation":[{"name":"Heart Rhythm Management Centre, Postgraduate Course in Cardiac Electrophysiology and Pacing Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel  Brussels Belgium"},{"name":"Electrophysiology Unit ZNA Middelheim  Antwerp Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yves","family":"De Greef","sequence":"additional","affiliation":[{"name":"Electrophysiology Unit ZNA Middelheim  Antwerp Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Schwagten","sequence":"additional","affiliation":[{"name":"Electrophysiology Unit ZNA Middelheim  Antwerp Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaspars","family":"Kupics","sequence":"additional","affiliation":[{"name":"Electrophysiology Unit ZNA Middelheim  Antwerp Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugo Enrique","family":"Couti\u00f1o","sequence":"additional","affiliation":[{"name":"Heart Rhythm Management Centre, Postgraduate Course in Cardiac Electrophysiology and Pacing Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel  Brussels 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