Procedural outcomes of single versus double transeptal access for ablation of atrial fibrillation: Data from the NCDR Afib ablation registry

The transeptal puncture (TSP) is an obligatory step during catheter ablation (CA) for atrial fibrillation (AF). There is no consensus regarding the utility for a single or double transeptal (TSP) access for CA of AF. To evaluate procedural outcomes and in-hospital complications (death, cardiovascular, neurological, peripheral vascular and pulmonary events) associated with CA of AF in patients undergoing single versus double TSP puncture using the National Cardiovascular Data Registry (NCDR). Clinical characteristics and procedural outcomes of patients undergoing CA for AF between 2016 and 2024 were evaluated. Inverse probability of Treatment Weighting (IPTW) analysis was developed to adjust for confounding variables between TSP groups. A total of 212,345 patients were identified. Among patients with paroxysmal AF (PAF) and non-paroxysmal AF (NPAF), single TSP was associated with comparable but lower risk of total procedural complications (PAF: 1.47% vs. 1.73%, OR:0.91, 0.88–0.93), (NPAF: 2.09% vs. 2.58%, OR:0.77 0.72–0.82), hospitalization > 1 day (PAF: 7.15% vs. 7.92%, OR:0.90, 0.87- 0.93), (NPAF: 10.41% vs. 12.13%, OR:0.84, 0.81–0.86) and a similar but higher likelihood of discharge in sinus rhythm (PAF: 95.55% vs. 95.17%, OR:1.09, 1.05–1.14) (NPAF: 93.37% vs. 92.31%, OR:1.17, 1.13–1.22) compared to double TSP technique. The incidence of stroke or TIA was not different between TSP groups. In a large AF ablation registry, single and double TSP use had similar procedural safety, and comparable likelihood of discharge in sinus rhythm. Single TSP use was not associated with embolism or cerebrovascular events. Operator preference and patient characteristics should be taken into consideration to define optimal TSP strategy.