Effectiveness and safety of single transseptal ablation for atrial fibrillation in real-word practice

Background: We have previously reported that unilateral groin-single transseptal (ST) ablation in patients with paroxysmal atrial fibrillation (AF) was safe and significantly reduced patient discomfort compared with bilateral groin-double transseptal (DT) ablation. Hypothesis: In the present study, we hypothesized that ST ablation would be as effective and safe as DT ablation in real-world practice like previous study. Among the 1765 consecutive patients in the Yonsei AF ablation cohort from October 2015 to January 2020, 1144 patients who underwent radiofrequency ablation were included for the analysis. Among them, 450 underwent ST ablation and 694 underwent DT ablation. Results: The total procedure time, ablation time, and fluoroscopy time were longer in the ST group than in the DT group (p <.05 for all). The hospital stay after catheter ablation was 1.3 ± 1.1 days which was longer in DT group than ST group (p =.001). No significant difference was observed in the complication rate (p =.263) and AF-free survival rate (log-rank p =.19) between the groups. However, after excluding patients who used antiarrhythmic drugs when AF recurred, the AF-free survival rates were lower in the DT group than in the ST group before and after propensity score matching (log-rank p =.026 and.047, respectively). Conclusion: Although the ST approach increases the procedure time compared with the DT approach owing to the need for more frequent catheter exchanges, the ST approach is a feasible and safe strategy for AF ablation in terms of rhythm outcomes and risk of complications.