Single versus double transseptal puncture for atrial fibrillation radiofrequency ablation: a systematic review and meta-analysis

Background The single puncture technique has emerged as an alternative to conventional double transseptal puncture for radiofrequency ablation of atrial fibrillation (AF). This meta-analysis aimed to compare the efficacy and safety of these two approaches. Methods We systematically searched PubMed, Embase, and the Cochrane Library up to 1st March, 2026. Prospective and retrospective cohort studies comparing single vs. double transseptal puncture during AF ablation were included. The primary outcome was the sinus rhythm maintenance. Secondary outcomes included total procedure time, fluoroscopy time, and periprocedural complications. Data were pooled using a random-effects model, and heterogeneity was assessed with the I² statistic. Results Four studies involving 1811 patients were included. No significant difference was observed in 3-month sinus rhythm maintenance between the single- and double-puncture groups (OR 1.20, 95% CI: 0.95–1.51, P = 0.13). While fluoroscopy time presented similar values (MD −0.84, 95% CI: −4.80–3.11, P = 0.68), procedure duration was significantly longer with single transseptal puncture (MD 11.65, 95% CI: 2.62–20.69, P = 0.01). The incidence of periprocedural complications was similar between the two strategies (OR 0.81, 95% CI: 0.47–1.38, P = 0.43). Conclusions Single transseptal puncture represents an effective and safe alternative to double puncture for atrial fibrillation ablation, with comparable rhythm outcomes, fluoroscopy exposure and complication rates, despite longer procedural duration. Systematic Review Registration https://www.crd.york.ac.uk/prospero/view/CRD420261300869 , Identifier: CRD420261300869.