PO-01-198 DOUBLE TROUBLE: HIGHER COMPLICATIONS AND INCREASED PROCEDURE TIMES WITH DOUBLE TRANSEPTAL PUNCTURE

Abstract

The three main techniques for transeptal access during catheter ablation (CA) of atrial fibrillation (AF) are double transeptal puncture (DTP), single transeptal puncture (STP), and single transeptal puncture with double access (STP-DA). It is unclear which of these techniques is the safest and most effective. To evaluate the periprocedural outcomes of DTP, STP, and STP-DA in patients undergoing first-time catheter ablation for paroxysmal atrial fibrillation. Consecutive patients undergoing first-time catheter ablation for paroxysmal AF performed by 67 operators in 43 centers were prospectively enrolled in the REAL-AF registry. The primary outcomes were procedural time and periprocedural complications. A total of 2,289 patients were included in the study. 379 underwent DTP, 612 underwent STP, and 1298 underwent STP-DA. The mean age was 65±10 years, 55% were male, the mean BMI was 30±7 kg/m2, and the mean CHA2DS2VASc score was 2.5±1.52 without statistically significant differences among the groups. Procedural time was 137.9±72.5 min. for DTP, 97.7±39.1 min. for STP, and 74±28.9 min. for STP-DA, with significant differences in ANOVA and independent t-test (p<0.001). Similarly, fluoroscopy time was 2.5±3.0 min for DTP, 1.8±2.0 min for STP, and 0.9±1.1 min for STP-DA, with significant differences in ANOVA and independent t-test (p<0.01). The complication rate was significantly higher in DTP compared to STP (1.3% vs. 0.2% | p=0.033), while there was no difference when comparing STP to STP-DA (1.3% vs. 0.7% | p=0.18). The use of DTP is associated with increased procedural time compared to STP or STP-DA. It is also associated with a significantly higher complication rate compared to STP. Interestingly, STP-DA was associated with a significant reduction in procedural times compared to STP, potentially due to the elimination of catheter exchange during the procedure.