Safety and feasibility of transseptal puncture with single femoral venous access utilizing a virtual coronary sinus catheter

Clin Res Cardiol (2025). DOI 10.1007/s00392-025-02625-4
R. Weinert (Neumünster)¹, T. Patzke (Neumünster)², R. Asbeck (Neumünster)², A. Schuchert (Neumünster)^3
1Friedrich-Ebert-Krankenhaus Neumünster GmbH Sektion Rhythmologie Neumünster, Deutschland; ²Friedrich-Ebert-Krankenhaus Neumünster GmbH Medizinische Klinik Neumünster, Deutschland; ³Friedrich-Ebert-Krankenhaus Neumünster GmbH Klinik für Kardiologie, Rhythmologie, Pneumologie und Allgemeine Innere Medizin Neumünster, Deutschland

Aim: In the light of an increasing prevalence of atrial fibrillation (AF) and growing evidence for the superiority of early invasive rhythm control, the demand for ablation therapy is rising. Accordingly, ablation centers will have to maximize their capacity and cut their costs by optimizing process management. Short procedure times and early ambulation and discharge therefore play an increasingly important role. Management of vascular access site is a critical part of early ambulation and discharge. We developed a new workflow for point by point radiofrequency pulmonary vein isolation with a single femoral venous access and closure of the venous puncture site with a suture-mediated closure system. The main obstacle we had to overcome was to develop a method für a safe transseptal puncture without the aid of a coronary sinus (CS) catheter in situ. Therefore, we introduced a virtual CS catheter by means of an image overlay technique originally developed for coronary interventions. The aim of this study is to show the safety and feasibillity of transeptal puncture with a single femoral venous access utilizing a virtual coronary sinus catheter.

Method: We analyzed 100 consecutive patients with paroxysmal or persistent AF undergoing pulmonary vein isolation (PVI). Feasibility was assessed as succesfully established access to the left atrium. Safety was assessed as rate of major complications intraprocedurally and within 30 days. 

Results: In 97 out of 100 patients we succesfully established access to the left atrium by this method. There were no major complications intraprocedurally and within 30 days.

 

Conclusion: Performing a transseptal puncture with a single femoral venous access utilizing a virtual coronary sinus catheter by means of an image overlay technique seems to be safe and feasible.