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.