ArticleJournal of arrhythmia2026
Comparison of Two ICE-Guided Transseptal Puncture Strategies for Zero-Fluoroscopy AF Ablation-A Randomized Controlled Trial.
Article in Journal of arrhythmia, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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6 authors.
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Abstract
Background: Transseptal puncture (TSP) is a critical step in left atrial (LA) access for atrial fibrillation (AF) ablation. Intracardiac echocardiography (ICE) combined with electroanatomical mapping now enables zero-fluoroscopy TSP in experienced practice. Two ICE-guided TSP strategies are used in contemporary clinical settings; however, their efficiency, safety, and learning curves have not been directly compared. Methods: This prospective randomized controlled trial was conducted at National Taiwan University Hospital between February 2023 and April 2024. Patients undergoing first-time AF ablation were randomized to two TSP strategies: Protocol A advanced the transseptal sheath from the superior vena cava to the fossa ovalis under ICE guidance, whereas Protocol B used a mapping catheter to identify the fossa and guide sheath positioning. Procedural duration, TSP metrics, and learning curve were assessed. Patients were followed for periprocedural complications and AF recurrence for one year. Results: Forty-three patients were enrolled (mean age 63.2 ± 9.8 years, 72.1% male). Zero fluoroscopy was achieved in all procedures, with no complications or crossover. Protocol A demonstrated shorter initial TSP times than Protocol B (8.5 ± 3.7 vs. 12.0 ± 5.4 min, Conclusions: Both ICE-guided strategies are safe and effective for zero-fluoroscopy TSP. Protocol A offers greater early efficiency, whereas Protocol B demonstrates rapid adaptability, supporting practical positioning of these complementary strategies in radiation-free AF ablation.
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