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. 2021;28(5):671-677.
doi: 10.5603/CJ.a2020.0037. Epub 2020 Mar 24.

Impact of single versus double transseptal puncture on outcome and complications in pulmonary vein isolation procedures

Annina Stauber  1 , Jelena Kornej  2 , Alireeza Sepehri Shamloo  2 , Boris Dinov  2 , Justinas Bacevicius  2 , Nikolaos Dagres  2 , Andreas Bollmann  2 , Gerhard Hindricks  2   3 , Philipp Sommer  2   3   4
Affiliations

Impact of single versus double transseptal puncture on outcome and complications in pulmonary vein isolation procedures

Annina Stauber et al. Cardiol J. 2021.

Abstract

Background: The aim of the current study was to analyze the impact of single versus double transseptal puncture (TSP) for atrial fibrillation (AF) ablation.

Methods: Consecutive patients undergoing AF ablation were prospectively included in the AF ablation registry and were analyzed according to single versus double TSP.

Results: A total of 478 patients (female 35%, persistent AF 67%) undergoing AF ablation between 01/2014 and 09/2014 were included. Single TSP was performed in 202 (42%) patients, double TSP in 276 (58%) patients. Age, gender, body mass index, CHA2DS2-VASc score, left ventricular ejection fraction and operator experience (experienced operator defined as ≥ 5 years of experience in invasive electrophysiology) were equally distributed between the two groups. Repeat procedures (re-dos) were more frequently performed using single TSP access (p < 0.001). Left atrial (LA) diameter was larger in patients with double TSP (p = 0.001). Procedure duration in single TSP was identical to double TSP procedures (p = 0.823). Radiation duration was similar between the two groups (p = 0.217). There were 49 (10%) patients with complications after catheter ablation. There were no differences between complication rates and TSP type (p = 0.555). Similarly, recurrence rates were comparable between both TSP groups (p = 0.788).

Conclusions: There was no clear benefit of single or double TSP in AF ablation.

Keywords: atrial fibrillation; catheter ablation; complications; pulmonary vein isolation; transseptal puncture.

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Conflict of interest statement

Conflict of interest: Philipp Sommer has received lecture fees and travel support from Abbott and is member of the advisory board for Abbott and Biosense Webster. Gerhard Hindricks and Nikolaos Dagres report research grants from Abbott and Boston Scientific to the institution (Heart Center Leipzig) without any personal financial benefits.

Figures

Figure 1
Figure 1
A. Left anterior oblique (LAO) 50° view. Single transseptal puncture; a — Agilis sheath (St. Jude, Abbott, St. Paul, MN, USA) in the left atrium with a 10 polar spiral-catheter in the left superior pulmonary vein; b — diagnostic catheter in the right ventricular apex; c — diagnostic catheter in the coronary sinus; d — temperature probe in esophagus; B. LAO 50° view. Double transseptal puncture; a — SL0 Sheath (St. Jude, Abbott, St. Paul, MN, USA) in the left atrium with a 10 polar spiral-catheter in the left superior pulmonary vein; b — Agilis sheath (St. Jude, Abbott, St. Paul, MN, USA) with ablation catheter ostial of the left superior pulmonary vein; c — diagnostic catheter in the right ventricular apex; d — diagnostic catheter in coronary sinus; e — temperature probe in the esophagus.
Figure 2
Figure 2
Electrocardiogramm during ablation. I, II, V1, V6 = Surface-electrocardiogram, MAP = ablation catheter, Lasso 1–10 = 10 polar spiral-catheter in the left superior pulmonary vein: a — farfield atrial signal; b — pulmonary vein signal; c — farfield ventricular signal; d — no pulmonary vein signal anymore; CS 1–10 — catheter in the coronary sinus; RVA — catheter in the right ventricular apex. The 10 polar spiral-catheter is placed in the left superior pulmonary vein. During ablation around the left superior pulmonary vein, the pulmonary vein signal on the spiral-catheter disappears (b → d). This means that the vein was isolated, because there was hence, no signal passing the ablation line.
Figure 3
Figure 3
A. Radiation dose in single and double transseptal puncture (TSP); B. Radiation time in single and double TSP; C. Recurrence in single and double TSP.
See this image and copyright information in PMC

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