Does the age affect the fluoroscopy-guided transseptal puncture in catheter ablation of atrial fibrillation?

Background: The anatomical differences with age may raise difficulty in determining the proper positioning of the transseptal puncture site in the therapeutic left heart catheterization. This study investigated whether age affects the fluoroscopy-guided transseptal puncture in the catheter ablation of atrial fibrillation. Methods and Results: Fifty patients (52 ± 12 years, 35 men) who underwent ablation for paroxysmal/persistent atrial fibrillation were included. The patients were divided into two groups according to their age (cut-point 50 y/o): young group (n = 20) and old group (n = 30). In the 30° right anterior oblique view (RAO), the width between the transseptal puncture site and coronary sinus ostium (H _N-CSO) was longer in old-age group (14.4 ± 9.4 vs 10.9 ± 10.4 mm, P = 0.034). In the 60° left anterior oblique view (LAO) view, the angle of the direction of the transseptal needle (N-angle) was less in the old-age group (56.0 ± 10.0° vs 58.4 ± 9.8°, P = 0.041). The ratio of the transseptal puncture site-coronary sinus ostium (CSO) distance over the distance between the superior vena cava-right atrial junction and CSO (V_N-CSO/V_J-CSO) was significantly higher in the old-age group (0.73 ± 0.12 vs 0.63 ± 0.2, P = 0.009). Conclusion: The transseptal puncture site in the RAO view moved higher and more posterior and the transseptal puncture angle in the LAO view decreased with age. These findings highlight the influence of age on the atrial anatomy and transseptal puncture site.