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

IF 5.7 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Heart rhythm Pub Date : 2025-09-01 Epub Date: 2025-04-03 DOI:10.1016/j.hrthm.2025.03.1996

Moneeb Khalaph MD , Philipp Lucas MD , Niklas Schenker MD , Andreas Rillig MD , Christian-Hendrik Heeger MD , Mustapha El Hamriti MD , Maxim Didenko MD , Sebastian Beyer MD , Denise Guckel MD , Thomas Fink MD , Vanessa Sciacca MD , Max Mörsdorf MD , Martin Braun MD , Maria Ivannikova MD , Werner Scholtz MD , Volker Rudolph MD , Guram Imnadze MD , Christian Sohns MD , Andreas Metzner MD , Philipp Sommer MD, FHRS

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Abstract

Background

Transseptal puncture (TSP) is critical for atrial fibrillation (AF) ablation. However, patients with atrial septal occluders (ASOs) for atrial septal defects (ASDs) or persistent foramen ovale (PFO) pose unique challenges.

Objective

This study aimed to evaluate the peri- and postprocedural safety, AF recurrence, and incidence of newly developed ASD/PFO up to 12 months postprocedure.

Methods

This multicenter, prospective observational study included 59 patients (mean age 61.2 ± 12.1 years, 56% male) with drug-refractory AF who underwent pulmonary vein isolation (PVI) between 2019 and 2024. Of these patients, 38 had ASDs and 21 had PFOs, with ASOs in situ. All punctures (single TSP) were performed under fluoroscopic guidance.

Results

The majority of TSP positions in the interatrial septum related to the ASO was inferior-posterior to the ASO (66.1%) or inferior-anterior (23.7%). In case of failure of the inferior part, puncture was performed in superior-posterior puncture (8.5%) or puncture through the occluder (1.7%). Mean ablation time was 14.9 ± 8.4 minutes, including radiofrequency (83.0%), cryoballoon (11.9%), and pulsed field ablation (5.1%). No major complications were observed, except for 1 transient phrenic nerve palsy during cryoballoon ablation, which recovered intraprocedurally. Voltage mapping revealed no additional substrate related to the occluder. During 12-month follow-up, 7 patients (11.9%) experienced AF recurrence.

Conclusion

TSP and PVI are safe and can be safely performed in patients with an ASO. No additional substrate related to the occluder was seen. Although no direct comparison was made, outcomes align with existing literature. Further studies are needed.

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经间隔穿刺治疗房颤患者的房间隔闭塞装置。

背景：经间隔穿刺（TSP）对房颤（AF）消融至关重要。然而，房间隔缺损（ASD）或持续性卵圆孔（PFO）的房间隔闭塞术（ASO）患者面临独特的挑战。目的：本研究旨在评估术后12个月新发ASD/PFO的围手术期和术后安全性、房颤复发和发生率。方法：这项多中心前瞻性观察研究纳入了59例在2019年至2024年间接受肺静脉隔离（PVI）治疗的难治性房颤患者（平均年龄61.2±12.1岁，56%为男性）。其中38人患有泛自闭症障碍，21人患有全氟辛烷磺酸，泛自闭症障碍仍然存在。所有穿刺（单次TSP）均在透视引导下进行。结果：与ASO相关的IAS中tsp位置以ASO后下位（66.1%）或前下位（23.7%）居多。如果下段穿刺失败，则采用上后路穿刺（8.5%）或通过咬合器穿刺（1.7%）。平均消融时间14.9±8.4 min，其中射频消融（83.0%）、低温球囊消融（11.9%）、脉冲场消融（5.1%）。除一例在低温球囊消融过程中短暂性膈神经麻痹外，无其他主要并发症。电压映射显示没有与封堵器相关的附加基板。在12个月的随访中，7例患者（11.9%）发生房颤复发。结论：TSP和PVI是安全的，可以安全地用于ASO患者。未见与封堵器相关的其他基底。虽然没有进行直接比较，但结果与现有文献一致。需要进一步的研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Heart rhythm 医学-心血管系统

CiteScore

10.50

自引率

5.50%

发文量

1465

审稿时长

24 days

期刊介绍： HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability. HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community. The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.