TRAVERSE
Trial question
What is the role of transseptal puncture approach in patients with LV arrhythmias undergoing catheter ablation procedures?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
21.0% female
79.0% male
N = 146
146 patients (30 female, 116 male).
Inclusion criteria: adult patients with LV arrhythmias undergoing catheter ablation procedures.
Key exclusion criteria: contraindication to MRI; contraindications to retrograde aortic approach or transseptal approach; planned epicardial ablation expected to require a periprocedural coronary angiogram; mental impairment that precludes accurate assessment of neurocognitive function or which may not allow patient to understand the nature, significance and scope of the study.
Interventions
N=74 transseptal puncture approach (transseptal aortic approach catheter ablation procedure).
N=72 retrograde aortic approach (retrograde aortic approach catheter ablation procedure).
Primary outcome
Acute brain lesion on postprocedural magnetic resonance imaging
28%
45%
45.0 %
33.8 %
22.5 %
11.3 %
0.0 %
Transseptal puncture
approach
Retrograde aortic
approach
Significant
decrease ▼
NNT = 5
Significant decrease in acute brain lesion on postprocedural MRI (28% vs. 45%; ARD -17, 95% CI -32.92 to -1.08).
Secondary outcomes
Significant increase in neurocognitive decline at 6 months (49% vs. 22%; ARD 7, 95% CI 1 to 13).
Conclusion
In adult patients with LV arrhythmias undergoing catheter ablation procedures, transseptal puncture approach was superior to retrograde aortic approach with respect to acute brain lesion on postprocedural MRI.
Reference
Gregory M Marcus, Roderick Tung, Edward P Gerstenfeld et al. Left Ventricular Entry to Reduce Brain Lesions During Catheter Ablation: A Randomized Trial. Circulation. 2025 Apr 15;151(15):1051-1059.
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