Transseptal Puncture in Patients with Septal Occluder Devices during Catheter Ablation of Atrial Fibrillation.

BACKGROUND The atrial septal occluder (ASO) becomes a major obstacle to the widespread adoption of atrial fibrillation (AF) catheter ablation in patients with prior atrial septal defects (ASD) closure. AIMS To describe the "Sequential Technique" of transseptal puncture (TSP) in AF patients with ASO. METHODS Sixty-four drug-refractory AF patients with ASO who underwent catheter ablation in our center from September 2007 to March 2020 were enrolled. RESULTS Puncture through the native septum was acquired 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 ± 2.1min, 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 that of Group A. In group B, 21 patients got the external sheath crossed the device by reshaping the needle and adjusting the puncture angle and position (Group B1), 12 patients got the external sheath crossed the device with assistance of the balloon dilation (Group B2). No patient had thrombus, periprocedural interatrial shunt and procedural complications. CONCLUSIONS TSP and AF ablation in patients with ASO are feasible and safe. The "Sequential Technique" could be safely used in patients with ASO.