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.