Modified Transseptal Technique Without Needle Puncture: Insights From a 4100-Procedure Registry

Fluoroscopy-guided transseptal puncture (TSP) remains essential for left atrial access, yet it carries rare but serious risks, including cardiac tamponade. We report outcomes from one of the largest single-center registries assessing a modified needle-free technique for TSP. 4100 procedures requiring TSP were analyzed. Subjects with patent foramen ovale (PFO) (n=322, 7.8%) were excluded from analysis. The modified needle-free rotational probing of the fossa ovalis with the assembly technique was applied in 1335 patients under fluoroscopic guidance. Successful left atrial catheterization was achieved in 960 patients (72%), while for the rest 375 (28%) patients conventional needle puncture was required. There were no major complications including pericardial effusion related to the non-puncture technique. The traditional needle approach was attempted in total in 2818 patients. Successful left atrial catheterization was achieved in 2813 patients (99.8%). Pericardial effusion without cardiac tamponade was developed in four out of 2818 patients (0.14%) that underwent the traditional approach. In 12 out of 4100 patients (0.29%), a false impression of PFO led to interatrial septum dissection. No pericardial effusion was noted in these cases. Transient ST-segment elevation during TSP was observed in four cases (0.1%). This large-scale registry derived from a high-volume center suggests that the modified needle-free technique may represent a safe alternative to conventional TSP and could serve as a useful adjunct or an intermediate step in the TSP learning curve.