SPC365

Single versus double transeptal puncture in catheter ablation of atrial fibrillation: characterization and long-term outcomes in a single tertiary center

Session: Comunicações Orais - Sessão 03 - Fibrilhação auricular - Inovações no tratamento ablativo
Speaker: Bárbara Lacerda Teixeira

Congress: CPC 2023
Topic: C. Arrhythmias and Device Therapy
Theme: 04. Arrhythmias, General
Subtheme: 04.4 Arrhythmias, General – Treatment
Session Type: Comunicações Orais
FP Number: ---
Authors: Bárbara Lacerda Teixeira; Pedro Silva Cunha; Ana Rita Teixeira; Ana Sofia Jacinto; Guilherme Portugal; Bruno Valente; Madalena Coutinho Cruz; Ana Lousinha; Ana Sofia Delgado; Manuel Bras; Margarida Paulo; Cátia Guerra; Rui Cruz Ferreira; Mário Oliveira

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">Background</span></span></span></strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">:&nbsp;An ablation catheter in conjunction with a circular mapping catheter (CMC) requiring a double transeptal puncture (TSP) for left atrial access is conventionally used for atrial fibrillation (AF) ablation in the majority of centers. In the recent years, different operators have combined a single transseptal puncture technique with 3D high-density mapping catheters for pulmonary veins isolation (PVI) in AF patients. </span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">Objective</span></span></span></strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">:&nbsp;The aim of this analysis is to compare two different strategies, single versus double TSP, regarding duration of the procedure, radiation dose, complications and long-term outcomes.</span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">Methods</span></span></span></strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">:&nbsp;retrospective analysis of an AF large cohort of consecutive patients that underwent PVI with radiofrequency energy (RF) using a 3D mapping system, either with single or double TSP, from 2016 to 2020.</span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">Results</span></span></span></strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">: we included 341 patients (female 35,8 %, paroxysmal AF 64,2 %) who underwent catheter ablation with RF. At the time of the ablation, age was 59,1 &plusmn; 11,8 years old, and the mean CHA2DS2-VASc score was 1,6 &plusmn; 1,3. All patients were taking oral anticoagulation.&nbsp; Single TSP was performed in 165 (48,4%) patients and double TSP in 176 (51,6%) patients. In 56 (16,4%) cases (50 [30,3%] in the single TSP and 6 [3,4%] in the double TSP), the procedure was a repeat ablation after AF recurrence. O</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">perator experience (defined as </span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">&ge;</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">5 years of AF ablation procedures) was equally distributed between the two groups. The average procedure time single (129 &plusmn; 33,2 minutes vs. 122 &plusmn; 34,9 minutes, for single and double TSP, respectively) did not reach statistical difference between the two groups (p = 0,55), but there was a significant difference regarding fluoroscopy time (13 &plusmn; 6,3 vs. 19 &plusmn; 9,1, for single and double TSP, respectively; p &lt; 0,001). Acute complications were less frequent in the single TSP approach (5,6 % vs. 9,7 %, for single and double TSP, respectively), but did not reach statistical significance (p = 0,181). At 4-year follow-up, sinus rhythm maintenance rate was equal in both groups (72,7%). </span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"><span style="background-color:white">The Kaplan-Meier survival curves revealed no difference in </span></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">AF recurrence <span style="color:black"><span style="background-color:white">between the two groups during the follow-up time of 4 years (log- rank p = 0,975). However, further analysis of subgroups according to type of AF revealed a significant difference among the subgroup with persistent AF submitted to double TSP (log rank p = 0,007).</span></span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">Conclusion</span></span></span></strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">:&nbsp;A simplified single-TSP technique using high-density multi-electrode 3D mapping is a safe and highly successful approach for AF ablation. This approach yields a substantial reduction in fluoroscopy time, with the potential to avoid acute complications when compared to a conventional double-TSP strategy. Long-term outcomes are similar between groups, although our analysis suggests that patients with&nbsp;<span style="background-color:white">persistent AF submitted to double-TSP present a statistically significant lower survival free from recurrence.</span></span></span></span></span></span></span></p>