Transseptal puncture in patients with septal occluder devices during catheter ablation of atrial fibrillation.

Abstract

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. The aim of this study was to describe the 'sequential technique' of transseptal puncture (TSP) in AF patients with ASO. Sixty-four drug-refractory AF patients with ASO who underwent catheter ablation in our centre from September 2007 to March 2020 were enrolled. 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. TSP and AF ablation in patients with ASO are feasible and safe. The 'sequential technique' could be safely used in patients with ASO.