Impact of transseptal puncture site on acute and mid-term outcomes during cryoballoon ablation: a comparison between anterior, medial and posterior transatrial access.
BACKGROUND
Cryoballoon ablation (CBA) (Arctic Front, Medtronic, USA) has proven very effective in achieving pulmonary vein isolation (PVI). Different transseptal (TS) puncture sites might influence CBA procedure. The aim of the present study was to analyze the influence of different TS puncture sites (anterior, medial and posterior) on the acute and midterm outcomes of CBA in a series of patients undergoing PVI for drug resistant AF.


RESULTS
A total 103 patients (78 males, mean age: 57 ± 13 years) formed the study group. Transseptal punctures were performed in the anterior, medial and posterior portion of the FO in 41 (39.8%), 35 (34%) and 27 (26.2%) patients respectively. We found no statistical significant difference between the various sites of TS puncture in 1) the grade of PV occlusion (p = ns), the rate of PV isolation (p = ns), freedom from AF at a mean 12 month follow-up (p = ns) and complication rates (p = ns). Mean grade of occlusion was slightly lower in the RIPV when puncturing in the posterior FO but did not reach statistical significance. Mean procedural and fluoroscopy times were significantly lower when using the inner lumen mapping catheter (ILMC) (Achieve, Medtronic, USA) than the circular mapping catheter (CMC) (Lasso, Biosense Webster, California, USA) (107.24 mn vs 97.74 (p ≤ 0.001) and 25.7 mn vs 19.2 mn (p ≤ 0.001)).


CONCLUSIONS
Different sites of TS puncture on the horizontal axis of the FO (anterior, medial and posterior) did not influence grades of PV occlusion, rates of isolation, mid-term outcome and rates of complications during CB ablation.
Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium; Modulo di Elettrofisiologia Cardiaca, Ospedale Santissima Trinità, Cagliari, Italy. Electronic address: gbchier@yahoo.it.
Gian-Battista
GB
Chierchia
Ruben
R
Casado-Arroyo
Carlo
C
de Asmundis
Moises
M
Rodriguez-Manero
Andrea
A
Sarkozy
Giulio
G
Conte
Juan
J
Sieira
Moises
M
Levinstein
Giannis
G
Baltogiannis
Giacomo
G
di Giovanni
Ingrid
I
Overeinder
Salvatore
S
Ocello
Eligio
E
Rosas
Francesco
F
Isola
Pedro
P
Brugada
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D003452:Cryosurgery / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006346:Heart Septum / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011677:Punctures; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
Atrial fibrillation; Cryoballoon; Transseptal puncture