Hellenic journal of cardiology : HJC = Hellenike kardiologike epitheorese · 2026
Modified transseptal technique without needle puncture: insights from a 4100-procedure registry.
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Letsas Konstantinos P, Kariki Ourania, Saplaouras Athanasios, Mililis Panagiotis, Dragasis Stelios, Koskina Stavroula, Efremidis Theodoros, Bazoukis George, Efremidis Michael
Аннотация
OBJECTIVE: Fluoroscopy-guided transseptal puncture (TSP) remains essential for left atrial access; however, it carries rare but serious risks, including cardiac tamponade. We report outcomes from one of the largest single-center registries assessing a modified needle-free technique for TSP.
METHODS: A total of 4100 procedures requiring TSP were analyzed.
RESULTS: Subjects with patent foramen ovale (PFO) (n = 322, 7.8%) were excluded from the analysis. The modified needle-free rotational probing of the fossa ovalis with the assembly technique was applied in 1335 patients under fluoroscopic guidance. Successful left atrial catheterization was achieved in 960 patients (72%), while conventional needle puncture was required in the remaining 375 (28%) patients. There were no major complications, including pericardial effusion, related to the non-puncture technique. The traditional needle approach was attempted in total in 2818 patients. Successful left atrial catheterization was achieved in 2813 patients (99.8%). Pericardial effusion without cardiac tamponade developed in four out of 2818 patients (0.14%) who underwent the traditional approach. In 12 out of 4100 patients (0.29%), a false impression of PFO led to interatrial septum dissection. No pericardial effusion was noted in these cases. Transient ST-segment elevation during TSP was observed in four cases (0.1%).
CONCLUSION: This large-scale registry derived from a high-volume center suggests that the modified needle-free technique may represent a safe alternative to conventional TSP and could serve as a useful adjunct or an intermediate step in the TSP learning curve.
METHODS: A total of 4100 procedures requiring TSP were analyzed.
RESULTS: Subjects with patent foramen ovale (PFO) (n = 322, 7.8%) were excluded from the analysis. The modified needle-free rotational probing of the fossa ovalis with the assembly technique was applied in 1335 patients under fluoroscopic guidance. Successful left atrial catheterization was achieved in 960 patients (72%), while conventional needle puncture was required in the remaining 375 (28%) patients. There were no major complications, including pericardial effusion, related to the non-puncture technique. The traditional needle approach was attempted in total in 2818 patients. Successful left atrial catheterization was achieved in 2813 patients (99.8%). Pericardial effusion without cardiac tamponade developed in four out of 2818 patients (0.14%) who underwent the traditional approach. In 12 out of 4100 patients (0.29%), a false impression of PFO led to interatrial septum dissection. No pericardial effusion was noted in these cases. Transient ST-segment elevation during TSP was observed in four cases (0.1%).
CONCLUSION: This large-scale registry derived from a high-volume center suggests that the modified needle-free technique may represent a safe alternative to conventional TSP and could serve as a useful adjunct or an intermediate step in the TSP learning curve.