Background: Transseptal puncture (TSP) is required for most catheter ablation (CA) procedures for atrial fibrillation (AF) because it enables left atrial access. In patients with atrial septal occluder (ASO) devices, device-related changes in septal anatomy may affect procedural planning, feasibility, and safety. We performed an updated systematic review and meta-analysis to evaluate reported outcomes of TSP-assisted CA in patients with ASO.
Methods: We searched PubMed, Embase, and the Cochrane Library from inception to April 28, 2026, including studies evaluating TSP-assisted CA in patients with ASO. Outcomes were AF recurrence, periprocedural complications, and procedural success, reported as proportions with 95% confidence intervals (CIs).
Results: Nine observational studies comprising 207 patients were included (36.7% female; mean age, 47.9 years; mean follow-up, 21.5 months). AF recurrence had a pooled incidence of 23.95% (95% CI 18.08% to 31.00%; I2 = 0.0%). In studies reporting 12-month follow-up, pooled AF recurrence was 18.18% (95% CI 10.07% to 30.60%; I2 = 0.0%). Periprocedural complication rate was 0.45% (95% CI 0.00% to 2.09%; I2 = 14.5%). Procedural success was 96.64% (95% CI 84.26% to 100.00%; I2 = 75.1%) and 97.87% (95% CI 86.38% to 99.70%; I2 = 0.0%) in a sensitivity analysis restricted to studies with comparable definitions.
Conclusion: Observational evidence suggests that TSP-assisted CA in patients with ASO is feasible and has a low reported complication rate in experienced centers, although the certainty of these findings is limited by small, noncomparative studies.
Keywords: Atrial fibrillation; Atrial septal defect; Atrial septal occluder devices; Catheter ablation; Transseptal puncture.
© 2026. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.