Why the study?
An atrial septal occluder represents a major obstacle to the widespread adoption of AF catheter ablation after prior ASD closure, prompting description of a sequential technique for transseptal puncture.
Is transseptal puncture using the 'sequential technique' feasible and safe during catheter ablation in drug-refractory AF patients with an atrial septal occluder?
Is transseptal puncture using the 'sequential technique' feasible and safe during catheter ablation in drug-refractory AF patients with an atrial septal occluder?
Transseptal puncture for AF ablation in patients with an atrial septal occluder is feasible and safe, though puncture through the device requires more time than through the native septum.
Supports procedural feasibility in AF ablation with occluders; leaves open safety, efficacy, and generalizability in larger trials.
BACKGROUND: An atrial septal occluder (ASO) represents a major obstacle to the widespread adoption of atrial fibrillation (AF) catheter ablation in patients with prior atrial septal defect (ASD) closure. AIMS: The aim of this study was to describe the 'sequential technique' of transseptal puncture (TSP) in AF patients with ASO. METHODS: Sixty-four drug-refractory AF patients with ASO who underwent catheter ablation in our centre from September 2007 to March 2020 were enrolled. RESULTS: Puncture through the native septum was achieved in 29 patients (Group A) and through the device in 35 patients (Group B). The mean diameter of the occluder was significantly larger in Group B than in Group A (31.6±4.6 mm vs 22.8±3.5 mm, p<0.001). The mean time of TSP (24.9±8.8 vs 5.8±2.1 min, p<0.001), total fluoroscopy time (23.7±10.9 vs 7.5±4.4 min, p<0.001), and total procedure time (172.7±58.3 vs 123.4±43.8 min, p=0.001) of Group B were significantly longer than those of Group A. In Group B, the external sheath crossed the device by reshaping the needle and adjusting the puncture angle and position in 23 patients (Group B1), while the external sheath crossed the device with the assistance of balloon dilation in 12 patients (Group B2). No patient had thrombus, periprocedural interatrial shunt or procedural complications. CONCLUSIONS: TSP and AF ablation in patients with ASO are feasible and safe. The 'sequential technique' could be safely used in patients with ASO.
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A 2022 study studied this question.
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