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Transseptal puncture for left atrial ablation: Risk factors for cardiac tamponade and a proposed causative classification system

Maclean, Edd; Mahtani, Karishma; Roelas, Marina; Vyas, Rohan; Butcher, Charles; Ahluwalia, Nikhil; Honarbakhsh, Shohreh; ... Segal, Oliver; + view all (2022) Transseptal puncture for left atrial ablation: Risk factors for cardiac tamponade and a proposed causative classification system. Journal of Cardiovascular Electrophysiology 10.1111/jce.15590. (In press). Green open access

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Abstract

Aims: Cardiac tamponade is a high morbidity complication of transseptal puncture (TSP). We examined the associations of TSP-related cardiac tamponade (TRCT) for all patients undergoing left atrial ablation at our center from 2016 to 2020. Methods and Results: Patient and procedural variables were extracted retrospectively. Cases of cardiac tamponade were scrutinized to adjudicate TSP culpability. Adjusted multivariate analysis examined predictors of TRCT. A total of 3239 consecutive TSPs were performed; cardiac tamponade occurred in 51 patients (incidence: 1.6%) and was adjudicated as TSP-related in 35 (incidence: 1.1%; 68.6% of all tamponades). Patients of above-median age [odds ratio (OR): 2.4 (1.19–4.2), p =.006] and those undergoing re-do procedures [OR: 1.95 (1.29–3.43, p =.042] were at higher risk of TRCT. Of the operator-dependent variables, choice of transseptal needle (Endrys vs. Brockenbrough, p >.1) or puncture sheath (Swartz vs. Mullins vs. Agilis vs. Vizigo vs. Cryosheath, all p >.1) did not predict TRCT. Adjusting for operator, equipment and demographics, failure to cross the septum first pass increased TRCT risk [OR: 4.42 (2.45–8.2), p =.001], whilst top quartile operator experience [OR: 0.4 (0.17–0.85), p =.002], transoesophageal echocardiogram [TOE prevalence: 26%, OR: 0.51 (0.11–0.94), p =.023], and use of the SafeSept transseptal guidewire [OR: 0.22 (0.08–0.62), p =.001] reduced TRCT risk. An increase in transseptal guidewire use over time (2016: 15.6%, 2020: 60.2%) correlated with an annual reduction in TRCT (R2 = 0.72, p <.001) and was associated with a relative risk reduction of 70%. Conclusions: During left atrial ablation, the risk of TRCT was reduced by operator experience, TOE-guidance, and use of a transseptal guidewire, and was increased by patient age, re-do procedures, and failure to cross the septum first pass.

Type: Article
Title: Transseptal puncture for left atrial ablation: Risk factors for cardiac tamponade and a proposed causative classification system
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/jce.15590
Publisher version: https://doi.org/10.1111/jce.15590
Language: English
Additional information: © 2022 The Authors. Journal of Cardiovascular Electrophysiology published by Wiley Periodicals LLC. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Keywords: cardiac tamponade, SafeSept guidewire, transoesophageal echocardiogram, transseptal puncture
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Clinical Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
URI: https://discovery.ucl.ac.uk/id/eprint/10151577
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