Introduction: transseptal (TS) puncture is required for a number of procedures in the left atrium (LA) or ventricle. Aim of this study is to assess efficacy and safety of a modified TS puncture technique using the stylet to cross the septum, taking advantage of its smaller cross sectional area (Fig. 1), and allowing smooth advancement of the needle over the stylet, avoiding perforation due to jumps related to excessive pressure of the TS-system. Methods: consecutive patients undergoing TS catheterization for catheter ablation, LA appendage (LAA) occlusion or follow up after pulmonary vein (PV) stenting have been included. Success and complication rates are reported. Results: since July 2013, 165 patients [65 (57, 73) years old, 74 (45%) female, 29 (26, 32) body mass index] underwent TS catheterization for catheter ablation (135, 82% -1 left sided slow pathway, 4 accessory pathways, 1 focal LA tachycardia, 117 atrial fibrillation, and 9 ventricular tachycardia ablation), LAA occlusion (29, 18.5%) and invasive follow up after PV stenting (1, 0.5%). No complications related to TS puncture were recorded, and puncture was successful in all, including 42 redo procedures (number of previous TS puncture 1.3 + 0.6). Conclusion: this modified TS puncture technique is highly effective and safe, and avoids the use of (expensive) dedicated systems in difficult cases.
Conflict of interest: none
PERIPROCEDURAL FACTORS ASSOCIATED WITH OUTCOME IN PAROXYSMAL ATRIAL FIBRILLATION. IS "CLEAN PULMONARY VEIN ISOLATION" ENOUGH?Doreen Schreiber, Berg Jan, Andreas Rieger, Moser Fabian, and Hans Kottkamp Zürich, Switzerland Background: Pulmonary vein (PV)-reconduction is accepted to be the main cause for AF-recurrences in patients (pts) with paroxysmal atrial fibrillation (PAF). Therefore, durable PV isolation (PVI) is a desired endpoint. Adenosine-induced transient reconduction, early AF recurrences but also preexisting fibrotic atrial cardiomyopathy (FACM) might affect catheter ablation success rates. Aim of this study was to evaluate if intraprocedural factors ("clean PVI") alone or in combination with postinterventional early recurrences or underlying FACM class are associated with ablation outcomes in PAF pts. Methods: 80 PAF pts underwent wide antral circumferential PVI (with electroanatomic voltage mapping during sinus rhythm). We retrospectively analyzed the following periprocedural criteria: 1) Direct isolation of the left and right PV-group by "single circle", no touch up ablation 2) Absence of spontaneous PV-reconduction after a waiting time of !30min(if reconduction: reisolation performed), 3) Absence of dormant reconduction tested by the administration of adenosine, 4) Detection of very early arrhythmia recurrences during postinterventional holter (7d), 5) FACM class 0-3. A "clean PVI" was concluded when the first three conditions were met. Follow-up was performed with 7-d-holters at 3/6/12/24mo (recurrence ¼ arrhythmia !30s). Results: Moderate to severe atrial fibrosis (FACM 2-3) was found in 30% (n ¼ 24) of our PAF pts. I...