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(BQ) Part 2 book "Transseptal catheterization and interventions" presents the following contents: Intracardiac echocardiography to guide transseptal puncture, transseptal catheterization for electrophysiology procedures in children and patients with congenital heart disease, transseptal left heart interventions, novel approaches and technology for transseptal catheterization,. | 8 Intracardiac EchơCARDioGRAPhY To Guide Transseptal Puncture 89 CONOR D. Barrett Luigi Di Biase J. David BuRkhARDT Rodney p. Horton ShELDON M. SiNGh Moussa Mansour Andrea Natale For many interventionalists who are train- ing in left atrial mapping and ablation gaining access to the left atrium LA is perceived as a stressful and challenging portion of the procedure. In expert hands transseptal punctures can be safely performed with the utilization of fluoroscopy alone but there are many instances where the additional information obtained by intracardiac echocardiography ICE is invaluable.1 2 This is more so when patients are therapeutically anticoagulated for the procedure when the inherent risks are higher. To reduce the periprocedural risk of stroke and access complications many centers now routinely perform atrial fibrillation AF ablation procedures while the patient is therapeutically anticoagulated with warfarin and administer heparin prior to the transseptal puncture.3-5 Transseptal Catheterization and Interventions. 2010 Ranjan Thakur MD and Andrea Natale MD eds. Cardiotext Publishing ISBN 978-0-9790164-1-7. Although for some procedures eg mapping of accessory pathways a retrograde aortic approach may be undertaken this obviously requires arterial access and increases the risk of access complications. A transseptal approach frequently is easier and necessary for left-sided pathway ablations and is obligatory in some patients eg those with severe aortic stenosis or with an artificial aortic valve . For other procedures in particular ablation for AF transseptal catheterization is obligatory.6 The usual location of transseptal puncture for AF ablation procedures is shown in Figure 8.1. Because of the inherent risks associated with transseptal puncture it makes sense that all necessary precautions are undertaken to ensure the safety of the procedure. In an analogous situation it has been previously observed that central venous access complications including the
