Among patients undergoing atrial fibrillation (AFib) ablation, single and double transeptal puncture (TSP) exhibited similar procedural safety and likelihood of discharge in sinus rhythm, according to a recent study published in the Journal of Interventional Cardiac Electrophysiology.

Including 212,345 patients captured by the ACC's AFib Ablation Registry from 2016 to 2024, Alejandro Velasco, MD, FACC, et al., compared procedural outcomes and in-hospital complications in patients undergoing catheter ablation for AFib via single or double TSP.

In patients where single TSP was used, the authors found comparable but lower risk of procedural complications (paroxysmal AFib [PAF]: 1.47% vs. 1.73%, OR, 0.91, 0.88-0.93; nonparoxysmal AFib [NPAF, 2.09% vs. 2.58%, OR, 0.77, 0.72-0.82) vs. those where double TSP was employed. Patients with single TSP also had 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). There was no difference in stroke between groups.

Study limitations included its observational design, lack of long-term recurrence data and unmeasured confounding variables such as patient complexity, left atrial substrate, operator's experience and center volume.

"Overall, our registry was able to show that both TSP techniques are comparable with a difference in procedural complication rates between groups below 1%," write the authors. "...Operator preference and patient characteristics should be taken into consideration to define optimal TSP strategy for [catheter ablation of AFib]."