Application of the combined technique of novel transseptal puncture guidewire and steerable sheath in left atrial appendage occlusion: a preliminary feasibility case series.

OBJECTIVE: Transseptal puncture (TSP) is a critical step in left atrial appendage occlusion (LAAO) but presents certain technical challenges. Conventional puncture needles, due to their inherent rigidity, often cause unpredictable needle tip "bouncing" or upward migration at the moment of septal puncture, resulting in a high or suboptimal puncture site, which subsequently compromises the coaxial alignment between the sheath and the left atrial appendage (LAA). This study aims to evaluate the safety and feasibility of the novel transseptal puncture guidewire Accusafe™ used in combination with a steerable sheath Navigo™. METHODS: In this case series, 20 consecutive patients undergoing a one-stop procedure (LAAO combined with atrial fibrillation ablation) were enrolled. The first 10 patients underwent conventional transseptal puncture, while the latter 10 underwent transseptal puncture using Accusafe™. The primary endpoints included first-pass puncture success rate, incidence of post-puncture site migration, and coaxiality assessed by the angle between the delivery sheath and the central axis of the LAA on angiography. RESULTS: Transseptal puncture was successfully performed in all patients. The application of Accusafe™ in combination with a steerable sheath significantly reduced sheath migration, achieving a first-pass puncture success rate of 100%. Furthermore, Accusafe™ significantly improved sheath-LAA coaxiality, effectively simplified the occluder delivery and deployment process, shortened procedure time, and ensured an ideal occlusion outcome. CONCLUSION: Transseptal puncture via the Accusafe™ guidewire with steerable sheath improves first-pass puncture success rate, enhances puncture site accuracy, and optimizes sheath-LAA central axis coaxiality, thereby improving procedural efficiency and occlusion efficacy. These findings support further validation of its clinical value in larger, randomized controlled studies.