Novel transseptal guidewire facilitates successful puncture in repaired atrial septum: a case report

Novel transseptal guidewire facilitates successful puncture in repaired atrial septum: a case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Novel transseptal guidewire facilitates successful puncture in repaired atrial septum: a case report Jie An, Youquan Li, Ya Luo, Yin Tian, Yang Jiao, Jie Zhang, Min Xu, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6331725/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 26 Mar, 2026 Read the published version in BMC Cardiovascular Disorders → Version 1 posted 14 You are reading this latest preprint version Abstract Background: Post-repair atrial septal anatomical variations may increase transseptal puncture difficulty. While the novel AccuSafe guidewire shows clinical potential, its therapeutic efficacy requires further evidence-based validation. Case presentation: We report a case of post-ASD repair AF in which an initial ablation attempt at an external institution failed, resulting in recurrent palpitations, heart failure, and anxiety. At our center, the AccuSafe transseptal puncture guidewire was successfully employed to traverse the interatrial septum, followed by completion of radiofrequency ablation for atrial fibrillation. Conclusion : AccuSafe puncture guidewire demonstrates safety and efficacy in post-operative ASD repair. Atrial septal defect repair Atrial fibrillation Radiofrequency ablation AccuSafe guidewire Figures Figure 1 Figure 2 Figure 3 Introduction Atrial fibrillation (AF) following atrial septal defect (ASD) repair is not uncommon, especially as age increases. Transseptal puncture of the thickened and displaced septum presents significant technical challenges, often leading to unsuccessful AF ablation even with the assistance of intracardiac echocardiography (ICE) guidance. The AccuSafe transseptal puncture guidewire demonstrates strong penetrating capability, excellent stability, and eliminates the need for wire exchange. We present a case report evaluating its feasibility and safety in atrial septal puncture following ASD repair. Case presentation History of presentation A 73-year-old female patient with recurrent episodes of paroxysmal atrial fibrillation and atrial flutter, who has demonstrated poor response to antiarrhythmic drug therapy, has recently experienced repeated episodes of palpitations and anxiety. She is being referred to our hospital for electrophysiological studies and radiofrequency catheter ablation for atrial fibrillation. Past medical history The patient has no previous history of coronary heart disease, diabetes, hypertension, or cerebral infarction. Differential diagnosis During the patient's hospitalization, multiple electrocardiograms (ECGs) and a 24-hour Holter monitor consistently indicated episodes of paroxysmal atrial fibrillation and paroxysmal atrial flutter. The patient has no prior history of ventricular tachycardia or supraventricular tachycardia. Investigations Based on the patient's medical history, preoperative echocardiography, and contrast-enhanced CT, it was indicated that the patient had undergone atrial septal defect repair, with thickening of the atrial septum and the presence of a patch. The anteroposterior diameter of the left atrium was 40 mm, all of which suggested increased surgical complexity ( Figure 1 A-C ). Management The patient had been on long-term anticoagulation therapy with Rivaroxaban 15 mg qd, which was discontinued on the morning of the surgery. Antiarrhythmic medications were withheld for at least five half-lives prior to the procedure. The left femoral vein was punctured twice to place the ICE catheter and coronary sinus electrode. Left atrial and atrial septal modeling were performed using ICE, revealing thickening of the atrial septum and a hyperechoic patch ( Figure 1D and Video 1 ). The right femoral vein was punctured once to insert a fixed curved long sheath, and atrial septal puncture was performed under the guidance of ICE and X-ray, which showed a thickened and tough atrial septum. However, the puncture was successfully achieved on the first attempt using a new AccuSafe guidewire ( Figure 2 and Figure 3, Video 2 - 4 ). After successful puncture, the AccuSafe guidewire was advanced to the left superior pulmonary vein and directly into the sheath. Heparinization was administered, and the activated clotting time was maintained between 300-350 ms during the procedure. A multi-electrode catheter was introduced into the left atrium for modeling and substrate mapping. Given the good left atrial substrate under sinus rhythm, bilateral pulmonary vein isolation was performed. After completion of the ablation, electrophysiological studies did not induce atrial flutter, atrial fibrillation, or supraventricular tachycardia. Outcome and follow-up At one and three months postoperatively, 24-hour Holter monitoring showed no evidence of atrial fibrillation or atrial flutter. No serious complications such as late pericardial tamponade or left atrial-esophageal fistula were observed. Discussion After ASD repair, atrial fibrillation may occur as a complication. 1 However, factors such as the atrial septal patch and thickened septum often lead to failed transseptal puncture. This patient had a previous failed procedure outside the hospital and is now experiencing anxiety symptoms, making it particularly important to increase the success rate of transseptal puncture. The new AccuSafe guidewire offers the following advantages: 1. A sharp tip that enhances puncture capability, reduces puncture resistance, and provides a clear sense of breakthrough; 2. A soft J-shaped curve with an inward-facing tip, minimizing the risk of endocardial and left atrial injury, and ensuring safer entry into the pulmonary vein; 3. A platinum-tungsten alloy spring for easy visualization under X-ray; 4. A variable diameter design, with a softer and safer distal end of 0.014 inches and a stronger proximal end of 0.032 inches for easy sheath passage. Compared to conventional puncture methods, the AccuSafe guidewire allows immediate sheath insertion into the left atrium without the need for guidewire exchange, thereby increasing puncture success rates and reducing complications. The tip of the AccuSafe guidewire is sharp, posing risks such as accidental puncture into the coronary sinus, aorta, or left atrial posterior wall. Therefore, it is necessary to reduce these risks by combining ICE and X-ray imaging with the support of a steerable sheath. The AccuSafe guidewire represents a significant advancement in transseptal puncture technology, offering unparalleled precision and maneuverability for challenging anatomical scenarios. Its unique design facilitates successful septal crossing in complex cases including atrial septal aneurysms, hypertrophic or calcified interatrial septum, and post-interventional anatomies such as post-surgical repair or device closure. The detailed puncture process can be seen in Video 5 . Conclusion AccuSafe puncture guidewire demonstrates safety and efficacy in post-operative ASD repair. Abbreviations ASD atrial septal defect AF atrial fibrillation ICE intracardiac echocardiography ECGs electrocardiograms Declarations Ethics approval and consent to participate This patient and her families gave written informed consent for their personal or clinical details along with any identifying images to be published in this study. Consent for publication All presentations of the case report have consent for publication. Availability of data and materials All data generated or analysed during this study are included in this published article [and its supplementary information files] Competing interests The authors have declared that there are no financial and non-financial competing interests. Clinical Trial Number Not applicable Funding Fund Project of the Health Commission of Guizhou Province: gzwkj2023-303. Authors' contributions Jie An and Youquan Li conceived and designed the study; Ya Luo and Yin Tian acquired and analyzed the data; Yang Jiao and Jie Zhang interpreted the data; Jie An, Min Xu, and Jie Li prepared the figures and videos; and all authors drafted the manuscript or critically revised it for important intellectual content. All authors reviewed the manuscript. Acknowledgements: None References Jacquemart E, Bessière F, Combes N, et al. Incidence, risk factors, and outcomes of atrial arrhythmias in adult patients with atrioventricular septal defect.JACC. Clinical electrophysiology, 2022, 8:331-340. Additional Declarations No competing interests reported. Supplementary Files Video1.mp4 Video2.mp4 Video3.mp4 Vidoe4.mp4 Video5.mp4 Cite Share Download PDF Status: Published Journal Publication published 26 Mar, 2026 Read the published version in BMC Cardiovascular Disorders → Version 1 posted Editorial decision: Revision requested 24 Jan, 2026 Reviews received at journal 19 Jan, 2026 Reviews received at journal 14 Jan, 2026 Reviewers agreed at journal 08 Jan, 2026 Reviewers agreed at journal 04 Jan, 2026 Reviewers agreed at journal 16 May, 2025 Reviewers agreed at journal 16 May, 2025 Reviews received at journal 12 May, 2025 Reviewers agreed at journal 12 May, 2025 Reviewers invited by journal 30 Apr, 2025 Editor assigned by journal 25 Apr, 2025 Editor invited by journal 02 Apr, 2025 Submission checks completed at journal 01 Apr, 2025 First submitted to journal 01 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6331725","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":451740575,"identity":"9ebd6fd4-1f68-41e9-801a-fdb0f4ce1df4","order_by":0,"name":"Jie An","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1klEQVRIiWNgGAWjYBACNoaDDQc//vknZz//8QHitPAxHj54WLLhgLEBQ1oCcVrkmI8lH+BtOJBowJBjQKTD2M4YHJDccSfBnOHMxxtvGOzkdBsIaeEBaik88yzPsrF3s+UchmRjswOEtEgAtUiwMRczHObdJs3DcCBxG0Et8m8MDvCwMSc2HON5RqQWhmMJB3jbDiduOMPDRqyWwwcOS5xJM5acwWZsOceACL/INxxs/vihwkaOX4L54Y03FXZyBLWgAAkeIqMGWQupOkbBKBgFo2BEAAAwdUk4epjRpQAAAABJRU5ErkJggg==","orcid":"","institution":"The Third Affiliated Hospital of Zunyi Medical University, The First People's Hospital of Zunyi)","correspondingAuthor":true,"prefix":"","firstName":"Jie","middleName":"","lastName":"An","suffix":""},{"id":451740576,"identity":"d24877da-43c2-4547-9445-4d988106c768","order_by":1,"name":"Youquan Li","email":"","orcid":"","institution":"The Third Affiliated Hospital of Zunyi Medical University, The First People's Hospital of Zunyi)","correspondingAuthor":false,"prefix":"","firstName":"Youquan","middleName":"","lastName":"Li","suffix":""},{"id":451740579,"identity":"8821bb37-c1bc-46a2-8daf-172b3a1538f1","order_by":2,"name":"Ya Luo","email":"","orcid":"","institution":"The Third Affiliated Hospital of Zunyi Medical University, The First People's Hospital of Zunyi)","correspondingAuthor":false,"prefix":"","firstName":"Ya","middleName":"","lastName":"Luo","suffix":""},{"id":451740581,"identity":"56fbc497-1dbf-4246-a94e-696a5d4a351c","order_by":3,"name":"Yin Tian","email":"","orcid":"","institution":"The Third Affiliated Hospital of Zunyi Medical University, The First People's Hospital of Zunyi)","correspondingAuthor":false,"prefix":"","firstName":"Yin","middleName":"","lastName":"Tian","suffix":""},{"id":451740582,"identity":"6f99897c-1fde-45b2-89b9-d7734dde7bac","order_by":4,"name":"Yang Jiao","email":"","orcid":"","institution":"The Third Affiliated Hospital of Zunyi Medical University, The First People's Hospital of Zunyi)","correspondingAuthor":false,"prefix":"","firstName":"Yang","middleName":"","lastName":"Jiao","suffix":""},{"id":451740585,"identity":"00df8c44-ceda-4efc-82da-14f361c1aaed","order_by":5,"name":"Jie Zhang","email":"","orcid":"","institution":"The Third Affiliated Hospital of Zunyi Medical University, The First People's Hospital of Zunyi)","correspondingAuthor":false,"prefix":"","firstName":"Jie","middleName":"","lastName":"Zhang","suffix":""},{"id":451740587,"identity":"b80730a1-a0a7-43d2-b1ba-992c9179c3c7","order_by":6,"name":"Min Xu","email":"","orcid":"","institution":"The Third Affiliated Hospital of Zunyi Medical University, The First People's Hospital of Zunyi)","correspondingAuthor":false,"prefix":"","firstName":"Min","middleName":"","lastName":"Xu","suffix":""},{"id":451740588,"identity":"ae45fb2d-c1c8-47bb-8cbf-793c613ad7ea","order_by":7,"name":"Jie Li","email":"","orcid":"","institution":"The Third Affiliated Hospital of Zunyi Medical University, The First People's Hospital of Zunyi)","correspondingAuthor":false,"prefix":"","firstName":"Jie","middleName":"","lastName":"Li","suffix":""}],"badges":[],"createdAt":"2025-03-29 04:08:03","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6331725/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6331725/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12872-026-05746-4","type":"published","date":"2026-03-26T16:09:59+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":82300433,"identity":"5d634606-559b-41b5-8032-1ed82bc40ae1","added_by":"auto","created_at":"2025-05-08 20:47:39","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":625188,"visible":true,"origin":"","legend":"\u003cp\u003eMultiple imaging studies confirmed atrial septal defect repair.\u003c/p\u003e\n\u003cp\u003e(A) Transthoracic echocardiographic image. (B) \u0026nbsp;\u0026nbsp;Contrast-enhanced two-dimensional computed tomography image. (C) \u0026nbsp;\u0026nbsp;Three-dimensional computed tomographic reconstruction of the bilateral atria \u0026nbsp;\u0026nbsp;and the atrial septal patch. (D) Intracardiac echocardiographic image \u0026nbsp;\u0026nbsp;demonstrating the atrial septum and the atrial septal patch.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6331725/v1/7c31131788d4fcfdbf6a2098.jpg"},{"id":82301244,"identity":"201e908b-a6cd-4963-a3f3-081252182d64","added_by":"auto","created_at":"2025-05-08 20:55:39","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":44445,"visible":true,"origin":"","legend":"\u003cp\u003eTransseptal puncture guided by intracardiac \u0026nbsp;\u0026nbsp;echocardiography and X-ray.\u003c/p\u003e\n\u003cp\u003e(A) Intracardiac echocardiography adequately visualized \u0026nbsp;\u0026nbsp;the interatrial septum and the patch, and the puncture was successfully \u0026nbsp;\u0026nbsp;performed. (B) X-ray confirmed the successful puncture, with the tip of the \u0026nbsp;\u0026nbsp;AccuSafe guidewire forming a J-shape to avoid injury to the left atrial \u0026nbsp;\u0026nbsp;endocardium.\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6331725/v1/e3f5ba86495b9913ff6c23de.jpg"},{"id":82300442,"identity":"8e03323d-d090-4524-8ee7-7fd19f5189ba","added_by":"auto","created_at":"2025-05-08 20:47:40","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":457213,"visible":true,"origin":"","legend":"\u003cp\u003eAdvancement of a fixed curved long sheath into the left atrium guided by intracardiac echocardiography and X-ray imaging.\u003c/p\u003e\n\u003cp\u003e(A) Intracardiac echocardiography revealed a \u0026nbsp;\u0026nbsp;\"three-rail sign,\" indicating that both the sheath and the AccuSafe \u0026nbsp;\u0026nbsp;guidewire had entered the left atrium. (B) X-ray confirmation showed that the \u0026nbsp;\u0026nbsp;AccuSafe guidewire was successfully advanced into the left superior pulmonary \u0026nbsp;\u0026nbsp;vein, and the sheath was also successfully positioned.\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6331725/v1/83f13a561083fd7c47a902d2.jpg"},{"id":105755861,"identity":"c4d828f5-1389-484c-be6b-75f4c317ed74","added_by":"auto","created_at":"2026-03-30 16:31:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1575740,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6331725/v1/2eead447-8121-4258-ada0-ca00eae8449f.pdf"},{"id":82301249,"identity":"cce7d47b-824f-4b92-bb0a-74a77ae934ea","added_by":"auto","created_at":"2025-05-08 20:55:40","extension":"mp4","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":3068442,"visible":true,"origin":"","legend":"","description":"","filename":"Video1.mp4","url":"https://assets-eu.researchsquare.com/files/rs-6331725/v1/e3ad1a3959d994889f7f3f43.mp4"},{"id":82300443,"identity":"294ded6a-1939-4db4-9840-e037e5976cbb","added_by":"auto","created_at":"2025-05-08 20:47:40","extension":"mp4","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":4078290,"visible":true,"origin":"","legend":"","description":"","filename":"Video2.mp4","url":"https://assets-eu.researchsquare.com/files/rs-6331725/v1/d870d44d0f45efb04b72592c.mp4"},{"id":82301517,"identity":"1fcb7f5a-c0f9-4b43-888c-83d385b2072c","added_by":"auto","created_at":"2025-05-08 21:03:40","extension":"mp4","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":670026,"visible":true,"origin":"","legend":"","description":"","filename":"Video3.mp4","url":"https://assets-eu.researchsquare.com/files/rs-6331725/v1/37885baaca7027d7c7c13c06.mp4"},{"id":82301247,"identity":"f04b8932-2f80-430c-b147-a48d66883dfb","added_by":"auto","created_at":"2025-05-08 20:55:40","extension":"mp4","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":4204250,"visible":true,"origin":"","legend":"","description":"","filename":"Vidoe4.mp4","url":"https://assets-eu.researchsquare.com/files/rs-6331725/v1/5b602939ed9e5693ea80b70a.mp4"},{"id":82301254,"identity":"91237331-77ca-49f1-b709-f96bc82d9f4d","added_by":"auto","created_at":"2025-05-08 20:55:40","extension":"mp4","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":4041559,"visible":true,"origin":"","legend":"","description":"","filename":"Video5.mp4","url":"https://assets-eu.researchsquare.com/files/rs-6331725/v1/bdc5f3e9506b7e3b7db81281.mp4"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eNovel transseptal guidewire facilitates successful puncture in repaired atrial septum: a case report\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAtrial fibrillation (AF) following atrial septal defect (ASD) repair is not uncommon, especially as age increases. Transseptal puncture of the thickened and displaced septum presents significant technical challenges, often leading to unsuccessful AF ablation even with the assistance of intracardiac echocardiography (ICE) guidance.\u003c/p\u003e\n\u003cp\u003eThe AccuSafe transseptal puncture guidewire demonstrates strong penetrating capability, excellent stability, and eliminates the need for wire exchange. We present a case report evaluating its feasibility and safety in atrial septal puncture following ASD repair.\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003e\u003cstrong\u003eHistory of presentation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA 73-year-old female patient with recurrent episodes of paroxysmal atrial fibrillation and atrial flutter, who has demonstrated poor response to antiarrhythmic drug therapy, has recently experienced repeated episodes of palpitations and anxiety. She is being referred to our hospital for electrophysiological studies and radiofrequency catheter ablation for atrial fibrillation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePast medical history\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patient has no previous history of coronary heart disease, diabetes, hypertension, or cerebral infarction.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDifferential diagnosis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDuring the patient's hospitalization, multiple electrocardiograms (ECGs) and a 24-hour Holter monitor consistently indicated episodes of paroxysmal atrial fibrillation and paroxysmal atrial flutter. The patient has no prior history of ventricular tachycardia or supraventricular tachycardia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInvestigations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBased on the patient's medical history, preoperative echocardiography, and contrast-enhanced CT, it was indicated that the patient had undergone atrial septal defect repair, with thickening of the atrial septum and the presence of a patch. The anteroposterior diameter of the left atrium was 40 mm, all of which suggested increased surgical complexity (\u003cstrong\u003eFigure 1 A-C\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eManagement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patient had been on long-term anticoagulation therapy with Rivaroxaban 15 mg qd, which was discontinued on the morning of the surgery. Antiarrhythmic medications were withheld for at least five half-lives prior to the procedure. The left femoral vein was punctured twice to place the ICE catheter and coronary sinus electrode. Left atrial and atrial septal modeling were performed using ICE, revealing thickening of the atrial septum and a hyperechoic patch (\u003cstrong\u003eFigure 1D and Video 1\u003c/strong\u003e). The right femoral vein was punctured once to insert a fixed curved long sheath, and atrial septal puncture was performed under the guidance of ICE and X-ray, which showed a thickened and tough atrial septum. However, the puncture was successfully achieved on the first attempt using a new AccuSafe guidewire (\u003cstrong\u003eFigure 2 and Figure 3, Video 2 - 4\u003c/strong\u003e). After successful puncture, the AccuSafe guidewire was advanced to the left superior pulmonary vein and directly into the sheath. Heparinization was administered, and the activated clotting time was maintained between 300-350 ms during the procedure. A multi-electrode catheter was introduced into the left atrium for modeling and substrate mapping. Given the good left atrial substrate under sinus rhythm, bilateral pulmonary vein isolation was performed. After completion of the ablation, electrophysiological studies did not induce atrial flutter, atrial fibrillation, or supraventricular tachycardia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcome and follow-up\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAt one and three months postoperatively, 24-hour Holter monitoring showed no evidence of atrial fibrillation or atrial flutter. No serious complications such as late pericardial tamponade or left atrial-esophageal fistula were observed.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAfter ASD repair, atrial fibrillation may occur as a complication.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e However, factors such as the atrial septal patch and thickened septum often lead to failed transseptal puncture. This patient had a previous failed procedure outside the hospital and is now experiencing anxiety symptoms, making it particularly important to increase the success rate of transseptal puncture.\u003c/p\u003e \u003cp\u003eThe new AccuSafe guidewire offers the following advantages: 1. A sharp tip that enhances puncture capability, reduces puncture resistance, and provides a clear sense of breakthrough; 2. A soft J-shaped curve with an inward-facing tip, minimizing the risk of endocardial and left atrial injury, and ensuring safer entry into the pulmonary vein; 3. A platinum-tungsten alloy spring for easy visualization under X-ray; 4. A variable diameter design, with a softer and safer distal end of 0.014 inches and a stronger proximal end of 0.032 inches for easy sheath passage. Compared to conventional puncture methods, the AccuSafe guidewire allows immediate sheath insertion into the left atrium without the need for guidewire exchange, thereby increasing puncture success rates and reducing complications. The tip of the AccuSafe guidewire is sharp, posing risks such as accidental puncture into the coronary sinus, aorta, or left atrial posterior wall. Therefore, it is necessary to reduce these risks by combining ICE and X-ray imaging with the support of a steerable sheath.\u003c/p\u003e \u003cp\u003eThe AccuSafe guidewire represents a significant advancement in transseptal puncture technology, offering unparalleled precision and maneuverability for challenging anatomical scenarios. Its unique design facilitates successful septal crossing in complex cases including atrial septal aneurysms, hypertrophic or calcified interatrial septum, and post-interventional anatomies such as post-surgical repair or device closure. The detailed puncture process can be seen in \u003cb\u003eVideo 5\u003c/b\u003e.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eAccuSafe puncture guidewire demonstrates safety and efficacy in post-operative ASD repair.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eASD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eatrial septal defect\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eatrial fibrillation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eICE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eintracardiac echocardiography\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eECGs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eelectrocardiograms\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis patient and her families gave written informed consent for their personal or clinical details along with any identifying images to be published in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll presentations of the case report have consent for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article [and its supplementary information files]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have declared that there are no financial and non-financial competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFund Project of the Health Commission of Guizhou Province: gzwkj2023-303.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJie An and Youquan Li conceived and designed the study; Ya Luo and Yin Tian acquired and analyzed the data; Yang Jiao and Jie Zhang interpreted the data; Jie An, Min Xu, and Jie Li prepared the figures and videos; and all authors drafted the manuscript or critically revised it for important intellectual content. All authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e None\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eJacquemart E, Bessi\u0026egrave;re F, Combes N, et al. Incidence, risk factors, and outcomes of atrial arrhythmias in adult patients with atrioventricular septal defect.JACC. Clinical electrophysiology, 2022, 8:331-340.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Atrial septal defect repair, Atrial fibrillation, Radiofrequency ablation, AccuSafe guidewire","lastPublishedDoi":"10.21203/rs.3.rs-6331725/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6331725/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003ePost-repair atrial septal anatomical variations may increase transseptal puncture difficulty. While the novel AccuSafe guidewire shows clinical potential, its therapeutic efficacy requires further evidence-based validation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase presentation: \u003c/strong\u003eWe report a case of post-ASD repair AF in which an initial ablation attempt at an external institution failed, resulting in recurrent palpitations, heart failure, and anxiety. At our center, the AccuSafe transseptal puncture guidewire was successfully employed to traverse the interatrial septum, followed by completion of radiofrequency ablation for atrial fibrillation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: AccuSafe puncture guidewire demonstrates safety and efficacy in post-operative ASD repair.\u003c/p\u003e","manuscriptTitle":"Novel transseptal guidewire facilitates successful puncture in repaired atrial septum: a case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-08 20:47:35","doi":"10.21203/rs.3.rs-6331725/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-25T04:09:02+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-19T10:33:38+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-14T07:05:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"303636751022304768462251263160271660164","date":"2026-01-08T10:58:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"241701353595825368551745596470194172139","date":"2026-01-04T09:22:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"174233188067332997510520576942248526789","date":"2025-05-16T16:26:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"220871458217217921216784614623971290942","date":"2025-05-16T05:45:27+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-12T14:44:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"171717265591228504049437783500771499792","date":"2025-05-12T13:56:38+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-30T12:38:59+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-25T08:38:07+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-02T06:20:10+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-01T13:52:08+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cardiovascular Disorders","date":"2025-04-01T13:51:02+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5e2123ac-507d-4398-8cda-79cb892b3593","owner":[],"postedDate":"May 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-30T16:27:50+00:00","versionOfRecord":{"articleIdentity":"rs-6331725","link":"https://doi.org/10.1186/s12872-026-05746-4","journal":{"identity":"bmc-cardiovascular-disorders","isVorOnly":false,"title":"BMC Cardiovascular Disorders"},"publishedOn":"2026-03-26 16:09:59","publishedOnDateReadable":"March 26th, 2026"},"versionCreatedAt":"2025-05-08 20:47:35","video":"","vorDoi":"10.1186/s12872-026-05746-4","vorDoiUrl":"https://doi.org/10.1186/s12872-026-05746-4","workflowStages":[]},"version":"v1","identity":"rs-6331725","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6331725","identity":"rs-6331725","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}