title: Safety of single transseptal puncture for ablation of atrial fibrillation: retrospective study from a large cohort of patients.
abstract: BACKGROUND
  Transseptal puncture (TSP) is the conventional approach to assess the left atrial chamber. This technique has been widely used in interventional cardiology and, in the last years, this approach is mostly applied to electrophysiologic procedures. For atrial fibrillation (AF) ablation, two or more transseptal sheaths are often positioned in the left atrium in the majority of centers, therefore requiring two or more transseptal punctures. Theoretically, double puncture could bear additional risks or could increase the risk of persistence of septal defects. We reported the results of a retrospective analysis of a single transseptal puncture as a simplified approach for positioning multiple catheters in the left atrium during AF ablation.
  
  
  METHODS
  Between November 2003 and November 2005, 1,150 consecutive patients (mean age 54 +/- 8 years, 75% men) were considered for AF ablation and underwent single transseptal puncture for positioning multiple catheters in the left atrium.
  
  
  RESULTS
  In only 6 of 1,150 (0.5%) cases a second transseptal puncture was required to position the ablation catheter in the left atrium. Neither acute complications related to transseptal catheterization such as atrial or aortic perforations, pericardial tamponade, thrombotic formation, or air embolism, nor complications due to the attempts of crossing the septum with the ablation catheter were reported. In all cases, each mapping catheter was properly maneuvered at different sites in the left atrium and at the pulmonary veins. In no patient was a residual septal atrial defect after the transseptal maneuvers detected during a mean follow up of 14 +/- 2 months.
  
  
  CONCLUSIONS
  This retrospective study on a large cohort of patients shows that single transseptal puncture for positioning two or more catheters in the left atrium for AF ablation is a highly successful and safe maneuver with a very low morbidity in the majority of patients. This may avoid potential complications related to a second transseptal puncture.
authors: Cardiac Arrhythmia Center, St. Ambrogio's Clinical Institute, University of Milan, Milan, Italy.
authors: Rafael L
authors: RL
authors: Fagundes
authors: Massimo
authors: M
authors: Mantica
authors: Lucia
authors: L
authors: De Luca
authors: Giovanni
authors: G
authors: Forleo
authors: Augusto
authors: A
authors: Pappalardo
authors: Andrea
authors: A
authors: Avella
authors: Aureliano
authors: A
authors: Fraticelli
authors: Antonio
authors: A
authors: Dello Russo
authors: Michela
authors: M
authors: Casella
authors: Gemma
authors: G
authors: Pelargonio
authors: Claudio
authors: C
authors: Tondo
mesh_terms: D001281:Atrial Fibrillation / Q000401:mortality* / Q000601:surgery*; D017115:Catheter Ablation / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D006346:Heart Septum / Q000601:surgery*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011677:Punctures / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome