Transseptal puncture for left atrial ablation: Risk factors for cardiac tamponade and a proposed causative classification system. (17th June 2022)

• Record Type: Journal Article
• Authors: Maclean, Edd; Mahtani, Karishma; Roelas, Marina; Vyas, Rohan; Butcher, Charles; Ahluwalia, Nikhil; Honarbakhsh, Shohreh; Creta, Antonio; Finlay, Malcolm; Chow, Anthony; Earley, Mark; Sporton, Simon; Lowe, Martin; Sawhney, Vinit; Ezzat, Vivienne; Ahsan, Syed; Khan, Fakhar; Dhinoja, Mehul; Lambiase, Pier; Schilling, Richard; Hunter, Ross; Segal, Oliver
• Is Part Of: Journal of cardiovascular electrophysiology. Volume 33:Number 8(2022)
• Page Start: 1747
• Page End: 1755
• Publication Date: 2022-06-17
• Subjects: cardiac tamponade -- SafeSept guidewire -- transoesophageal echocardiogram -- transseptal puncture; Blood vessels -- Physiology -- Periodicals; Electrophysiology -- Periodicals; Heart -- Physiology -- Periodicals; 612.1
• DOI: 10.1111/jce.15590
• Languages: English
• ISSNs: 1045-3873

Abstract

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 ( R 2 = 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. Abstract : In this retrospective analysis of 3239 consecutive transseptal punctures performed during left atrial ablation, we present the independent risk factors for the occurrence of cardiac tamponade. We also propose a novel classification system for the causes of cardiac tamponade during left atrial ablation.