B-po03-117 cardiac tamponade as a complication of transseptal puncture: associations and operator-dependent variables at barts heart center

Cardiac tamponade is a high morbidity complication of transseptal puncture (TSP). We examined the incidence and predictors of TSP-related cardiac tamponade (TRCT) for all patients undergoing catheter ablation from 2016-2020. Patient and procedural variables were extracted retrospectively. Cases of cardiac tamponade were scrutinised to adjudicate TSP culpability. Adjusted multivariate analysis (C=0.84) examined predictors of TRCT (OR (95% CI)). 3,688 consecutive TSPs were performed; cardiac tamponade occurred in 67 patients (1.8%) and was adjudicated as TSP-related in 36 (0.97%). There was a trend towards TRCT in redo procedures (p=0.092), and patients of above-median age were at higher risk (OR 2.36 (1.24-4.4), p=0.008). Of the operator-dependent variables, transseptal needle (Endrys vs BRK, p>0.1), puncture sheath (Swartz vs Mullins vs Agilis vs Cryosheath, all p>0.1) or use of transoesophageal echo (p>0.1) did not predict TRCT. Adjusting for operator, indication, equipment and demographics, failure to cross the septum first pass increased TRCT risk (OR 4.77, 2.14-10.2, p=0.001), whilst above-median operator experience (OR 0.42 (0.21-0.86), p=0.018) and use of the Safesept wire (OR 0.23 (0.08-0.67), p=0.007) reduced TRCT risk. An increase in Safesept wire use over time (2018: 19.6%, 2019: 36.9%, 2020: 59.2%) correlated with an annual reduction in TRCT (R2=0.88, p=0.021) and was associated with a relative risk reduction of 75% (total cost to prevent a TRCT: $7,700). Predictors of TRCT were patient age, unsuccessful first pass, operator experience and use of the Safesept wire. Safesept wire use may improve patient safety.