Introduction
Transseptal access has been performed for over six decades under a variety of procedures in interventional cardiology.(1) It is routinely performed inside the electrophysiology (EP) laboratory, with a complication rate of less than 0.8% in different series.(2-4) Except for minor modifications, the technique has undergone small changes over the years.(5) Intracardiac echocardiography has been incorporated to provide real-time visualization of cardiac structures and to guide transseptal puncture(6), however, despite the increased safety, mechanical complications still occur and might lead to a fatal outcome when they are not recognized.(7)
The goal of this article is to describe an unusual strategy, which might be used in the management of inadvertent puncture of the posterior atrium wall during an attempt to access the left atrium in cases such as pulmonary vein isolation (PVI) in atrial fibrillation ablation. It is a viable strategy that can be used in case of cardiac perforation, when the operator suspects the sheath’s tip lies inside the pericardial space.