Introduction
Transseptal puncture (TSP) is the crucial step in a variety of cardiac procedures, including left side ablations1. The TSP technique was introduced into clinical practice during the late 1950s by Ross et al.2 , and over the years the procedure has remained unchanged, except for the introduction of a new needle by Brockenbrough3 in 1960s. TSP is a relatively safe procedure, even though complications related to TSP can be severe and life threatening, as a consequence special training is required, and only expert operators should perform TSP4. New technologies have been developed in order to simplify the puncture and increase its safety, however none of them has become the new standard tool for TSP. Recently a novel transseptal crossing device (AcQCross™️ Qx, Medtronic) was introduced: it has an integrated needle/dilator design, which removes the need for needle and guidewire exchange after TSP; it fits with the different existing sheaths; and the needle can also work with radiofrequency, in case of need. The aim of our paper is to describe our first experience with this novel technology applied for cryoballoon atrial fibrillation (AF) ablation, under fluoroscopy and pressure guidance.