Single transeptal puncture for atrial fibrillation ablation was associated with lower procedural complications and higher discharge rates in sinus rhythm compared to double transeptal puncture.
Does single transeptal access reduce procedural complications compared to double transeptal access in patients undergoing catheter ablation for atrial fibrillation?
In a large US registry, single transeptal access for atrial fibrillation ablation was associated with a slightly lower risk of in-hospital procedural complications and shorter hospital stays compared to double transeptal access, with comparable rates of discharge in sinus rhythm.
Absolute Event Rate: 0% vs 0%
The transeptal puncture (TSP) is an obligatory step during catheter ablation (CA) for atrial fibrillation (AF). There is no consensus regarding the utility for a single or double transeptal (TSP) access for CA of AF. To evaluate procedural outcomes and in-hospital complications (death, cardiovascular, neurological, peripheral vascular and pulmonary events) associated with CA of AF in patients undergoing single versus double TSP puncture using the National Cardiovascular Data Registry (NCDR). Clinical characteristics and procedural outcomes of patients undergoing CA for AF between 2016 and 2024 were evaluated. Inverse probability of Treatment Weighting (IPTW) analysis was developed to adjust for confounding variables between TSP groups. A total of 212,345 patients were identified. Among patients with paroxysmal AF (PAF) and non-paroxysmal AF (NPAF), single TSP was associated with comparable but lower risk of total procedural complications (PAF: 1.47% vs. 1.73%, OR:0.91, 0.88–0.93), (NPAF: 2.09% vs. 2.58%, OR:0.77 0.72–0.82), hospitalization > 1 day (PAF: 7.15% vs. 7.92%, OR:0.90, 0.87- 0.93), (NPAF: 10.41% vs. 12.13%, OR:0.84, 0.81–0.86) and a similar but higher likelihood of discharge in sinus rhythm (PAF: 95.55% vs. 95.17%, OR:1.09, 1.05–1.14) (NPAF: 93.37% vs. 92.31%, OR:1.17, 1.13–1.22) compared to double TSP technique. The incidence of stroke or TIA was not different between TSP groups. In a large AF ablation registry, single and double TSP use had similar procedural safety, and comparable likelihood of discharge in sinus rhythm. Single TSP use was not associated with embolism or cerebrovascular events. Operator preference and patient characteristics should be taken into consideration to define optimal TSP strategy.
“Overall, our registry was able to show that both TSP techniques are comparable with a difference in procedural complication rates between groups below 1%... Operator preference and patient characteristics should be taken into consideration to define optimal TSP strategy for [catheter ablation of ...”
Velasco et al. (Mon,) reported a other. Single transeptal puncture for atrial fibrillation ablation was associated with lower procedural complications and higher discharge rates in sinus rhythm compared to double transeptal puncture.