A novel and easy approach to difficult transseptal puncture during atrial fibrillation ablation
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A novel and easy approach to difficult transseptal puncture during atrial fibrillation ablation Changyi Li 1 & Jingrui Zhang 1 & Songnan Li 1 & Caihua Sang 1 & Nian Liu 1 & Xin Du 1 & Jianzeng Dong 1 & Changsheng Ma 1 Received: 26 March 2020 / Accepted: 28 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Aims Transseptal passage is sometimes difficult to obtain. This study evaluates the feasibility and safety of a novel and easy transseptal puncture (TSP) technique named 2D2G (using two dilators and two guidewires) in patients with difficult TSP. Methods and results Forty-four paroxysmal atrial fibrillation patients with difficult TSP were enrolled in this study. They were allocated to the 2D2G group or the conventional group in a 1:1 fashion. The primary endpoint in both groups was successful TSP without changing the puncture site or using auxiliary tools. The secondary endpoints were the safety, total transseptal puncture time, and ablation time. There were no differences in baseline demographic or clinical characteristics between the two groups. Successful LA access in the 2D2G group was 100% (vs. 64%, P < 0.05). The total TSP time (10 ± 3 min vs. 5 ± 1 min, P < 0.05) and ablation time (42 ± 19 min vs. 58 ± 22 min, P < 0.05) in the conventional group were significantly longer than those in the 2D2G group. No major complications occurred in either group, and all the patients underwent successful circumferential pulmonary vein isolation (CPVI). Conclusion In AF patients with difficult TSP, the 2D2G technique is safe, feasible, and time-saving. Keywords Difficult transseptal puncture . Ablation . Atrial fibrillation . Atrial septum
1 Introduction Catheter ablation has emerged as an effective alternative approach in patients with symptomatic, drug-refractory paroxysmal atrial fibrillation (AF) [1]. Transseptal puncture (TSP) is a conventional approach to access the left atrium (LA); this approach is necessary to perform pulmonary vein isolation (PVI), which is the cornerstone of AF ablation. In order to maintain long and lasting freedom from AF, patients probably undergo a second or additional ablation procedures [2]. Patients who have undergone prior AF ablation may have septal scarring and thickening at the sites of prior TSP, complicating repeat TSP [3, 4]. In addition, left atrial arrhythmias in patients with atrial septal occluders or in those who underwent previous valvular surgery are also common; TSP may be difficult in these patients [5].
A variety of approaches to difficult TSPs have been devised to date, such as using an electrocautery pen to cauterize the proximal part of the transseptal needle [6], delivering radiofrequency energy to the tip of the transseptal needle [7, 8], applying a steerable needle [9], and requiring ancillary tools [10]. Our centre previously introduced a novel technique using balloon dilatation to access the left atrium in atrial septal defect (ASD) patients with ASO and corroborated the feasibility and safety of this technique [11].
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