Mitigating Transseptal Puncture Complications by Guiding with an Angioplasty Wire and an Electrified Brockenbrough...

Transeptal puncture (TSP) is an important technique in catheter ablation and structural interventions. Several novel techniques and equipment have been developed, however they are limited by availability and cost.

To evaluate the efficacy and safety of a modified TSP technique guided by a 0.014″ angioplasty wire and an electrified Brockenbrough (BRK) stylet.

One hundred consecutive patients who received the modified TSP technique and another 100 undergoing conventional TSP for pulmonary vein isolation for non-valvular atrial fibrillation from January 2019 to January 2023 were retrospectively analyzed. A historical comparison with three associated studies was performed. Age, gender, left atrial diameter, left ventricular ejection fraction, acute complications, and BRK needle jump distances during TSP were analyzed.

Both groups demonstrated comparable characteristics, including age (conventional TSP vs. modified TSP; 65.8 ± 9.6 vs. 63.63 ± 10.3 years; p = 0.077), sex (conventional TSP vs. modified TSP; males, 75% vs. 67%; p = 0.213), and left atrial diameter (conventional TSP vs. modified TSP; 40.55 ± 7.7 vs. 42.60 ± 8.2 mm; p = 0.069). All received continuous periprocedural nonvitamin K oral anticoagulants and underwent TSP with a BRK needle. There was no acute pericardial effusion or tamponade immediately after TSP or at the end of catheter ablation. Inadvertent jump of the BRK needle was significantly attenuated in the modified TSP group (conventional TSP vs. modified TSP; 0.766 ± 0.19 vs. 1.455 ± 0.48 cm; p < 0.001). No TSP-related complications were observed.

The modified TSP technique using readily available equipment with an electrified stylet and a 0.014″ angioplasty wire is a simple, safe, and cost-effective alternative. This method reduces the built-up tension by mechanical force during tenting and minimizes the risk of inadvertent jumping.