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Transseptal catheterization is routinely used for numerous ablation procedures, including ablation of atrial fibrillation (AF), accessory pathways, focal atrial tachycardias, and ventricular tachycardias.Moreover, transseptal puncture (TSP) is used for the occlusion of left atrial appendages or mitral valve repair. The original technique introduced by Ross in 1959 has evolved into a widely used standard procedure with low complication rates over time. However, presence of atrial septum aneurysm, thickened interatrial septum (IAS), or previous TSP may result in a challenging task with elevated risk. We here present a case report of TSP in a patient with IAS aneurysm, provide a detailed description of the TSP implementation, and recommend on complication prevention.

Complication prevention in ablation procedures: How to perform transseptal puncture safely in case of atrial septum aneurysm