Adverse events
Overall procedural complication rate in our study was low (1.9%) and adverse events unequivocally attributable to TSP were even lower. In the setting of uninterrupted anticoagulation, there are several mechanisms of cardiac perforation during CA procedure including mechanical trauma of thin LA walls, coronary sinus perforation and steam pops during RF energy delivery. However, with various technological improvements of ablation catheters to reduce perforation risk TSP seems to be the pivotal step in achieving CA procedure safety. We observed only one pericardial tamponade following double transseptal access for AF ablation procedure, which accounts for only 0.2% of all TSPs. Safety profile of our procedures is very similar to the recent publication on fluoroless ICE-guided TSPs by Baykaner et al. (9) that also reported very low pericardial tamponade (0.2%) and overall complication rate (0.7%). Studies with large number of predominantly fluoroscopy-guided CA procedures also report relatively low TSP-related complications rates of 0.8% and 0.7%, respectively (1,3). On the other hand, some “real life” registries record higher pericardial tamponade rates of 1.2% (2) and 1.3% (17), respectively. Different adverse event definitions, study populations, and CA techniques could have attributed to the discrepancies of the results. In addition, nonuse of ICE was recognized as one of the strongest independent predictors of cardiac perforation in recent analysis of 102,398 patients who underwent AF ablation (18). In line with our observations, the study acknowledges wider adoption of intraprocedural ICE use to increase safety of CA procedures.