Background:

Catheter ablation, requiring transseptal access, is sometimes challenging in patients with previous septal surgery or implanted septal devices. However, especially in patients with previous septal interventions cardiac arrhythmias e.g. atrial fibrillation (AF) or atrial flutter are frequent. The present study aimed at investigating the safety and efficacy of transseptal access in a collective with different previous septal interventions.

Methods and results:

From our prospective EP-registry 61 patients with previous surgical or interventional treated atrial septum defect (ASD) or patent foramen ovale (PFO) were analyzed. The majority of patients (76%) right atrial arrhythmias, while 19 patients (24%) showed left sided arrhythmias requiring transseptal puncture (TSP).

All TSPs were performed under fluoroscopy without intraprocedural transoesophageal echocardiography (TOE) or intracardiac echography (ICE). Most patients had previous atrial septal defect (ASD: 74%), followed by patent foramen ovale (PFO: 26%). 74% (14/19) of the patients had a surgical septal suture and 26% (6/19) had a previous interventional closure. The underlying arrhythmias requiring transseptal puncture were predominantly supraventricular tachycardias (SVT) (84%, mainly AF (74%)) followed by ventricular tachycardias (16%). TSP was successful in 18 out of 19 patients. In the case of implanted septal devices, the TSP was performed through the device in 2 out of 6 patients. Complications were rare in this collective, a pericardial puncture without consequences occurred in one patient, and in one patient TSP was not possible because of immense septal stiffness.

Procedure times, fluoroscopy duration and radiation did not significantly differ between this collective and matched patients without previous septal interventions from our center.

Conclusion:

Transseptal puncture without TOE or ICE is safe and effective to achieve left atrial access even in patients with complex septal anatomy.