How to perform a transseptal puncture

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Abstract
The left atrium (LA) is the most difficult cardiac chamber to access percutaneously. Although it can be reached via the left ventricle and mitral valve, manipulation of catheters that have made two 180° turns is cumbersome. The transseptal puncture permits a direct route to the LA via the intra-atrial septum and systemic venous system. Previously the technique was used infrequently by cardiologists for mitral valvuloplasty and ablation in the left heart; however, the explosion of interest in catheter ablation of atrial fibrillation (AF) has meant the transseptal puncture is a routine skill of the modern cardiac electrophysiologist. This article looks at the practical aspects of this important procedure, particularly as applied to the cardiac electrophysiologist.

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