Transseptal Puncture: Best Practice and Techniques

Transseptal left atrial puncture was described over 60 years ago and has been adapted for a variety of procedures, including left atrial appendage (LAA) closure. Achieving safe transseptal access is crucial for the deployment of LAAO devices. Understanding the anatomy of the IAS combined with the effective use of the available transseptal tools, including echocardiography, various sheaths, and transseptal needles, is a key factor in the safety and effectiveness of LAAO. It is also important to be able to troubleshoot a challenging transseptal access (e.g., elastic, fibrosed, or aneurysmal septum) and promptly recognize and treat potential complications. Prompt identification and management of complications during transseptal puncture is of utmost importance to prevent morbidity and mortality events.