Minimally invasive approach to RF-pulmonary vein isolation using only a single groin puncture

Nadja Martins (Berlin)1, V. Tscholl (Berlin)2, P. Nagel (Berlin)1, U. Landmesser (Berlin)1, G. Hindricks (Berlin)2, P. Attanasio (Berlin)1, M. Huemer (Berlin)1

1Deutsches Herzzentrum der Charite (DHZC) Klinik für Kardiologie, Angiologie und Intensivmedizin | CBF Berlin, Deutschland; 2Deutsches Herzzentrum der Charite (DHZC) Innere Medizin-Kardiologie Berlin, Deutschland


Pulmonary vein isolation (PVI) is a highly effective procedure in the treatment of atrial fibrillation. As more and more PVIs are performed in ambulatory patients, a minimally invasive approach is useful to minimize the risk of vascular complications.
This study was designed to establish a minimally invasive approach to RF-pulmonary vein isolation using only one single groin puncture with a single 8.5 French sheath.

Methods and Results:
A total of 23 patients (average age 69.7, 52.2% female) undergoing first pulmonary vein isolation were included. Baseline characteristics are shown in table 1.
After single puncture of the right femoral vein a steerable sheath (Agilis™ NXT, St Jude Medical, St Paul, MN, USA) was used to place a wire in the coronary sinus. The sheath was then retracted to the inferior vena cava and a second wire was placed into the superior vena cava (see figure 1). The sheath was then removed and repositioned over the second wire (see figure 2). 
Using the first wire in the distal coronary sinus for orientation, transseptal puncture was performed. After left atrial access, this first wire was removed. Success rates of this approach are shown in table 1.
Figure 1: AP view. The first wire is placed in the coronary sinus, while the second is in the vena cava inferior.
Figure 2: LAO 60°showing the sheath in the vena cava superior after being repositioned over the second wire.
A single groin puncture procedure is feasible for patients undergoing a first pulmonary vein isolation. Single groin puncture is a way to simplify the ablation procedure and has the potential to reduce the risk of complications.
Average age (years) 69.7 ± 7.71 
Female gender, n (%) 12 (52.2%)
Average EF, % 53 ± 13.9
Paroxysmal fibrillation, n (%) 10/23 (43.5%)
Wire displacement during transseptal puncture, n (%) 2/23 (8.7%)
Use of terumo wire for CS necessary, n (%) 1/23 (4.3%)
CS wire placement unsuccessful, n (%) 3/23 (13%)
Table 1: baseline characteristics and procedure parameters
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