Taking a Detour: Step-by-Step Alternative Approaches to Transseptal Access
Worawan B Limpitikul1, Vincent Wu2, Kei Yamada3
1Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Journal of Cardiovascular Electrophysiology
|May 23, 2025
Summary
Transseptal puncture is crucial for electrophysiology but challenging with inferior vena cava (IVC) obstruction. Alternative transhepatic and superior approaches offer safe and feasible access to the left atrium when standard methods fail.
Area of Science:
- Cardiology
- Interventional Electrophysiology
Background:
- Transseptal puncture via the femoral vein and inferior vena cava (IVC) is standard for accessing the left atrium/ventricle in electrophysiology.
- IVC obstruction, due to congenital or acquired conditions, renders the standard approach impossible.
Purpose of the Study:
- To describe alternative transseptal access methods for patients with IVC obstruction.
- To evaluate the feasibility and safety of these alternative approaches.
Main Methods:
- Detailed step-by-step description of transhepatic and superior (internal jugular/axillary vein) transseptal access.
- Emphasis on preprocedural planning using multi-modal imaging.
Main Results:
- Alternative transseptal access methods were successfully employed.
- These approaches provide feasible and safe routes for electrophysiology procedures.
Conclusions:
- Transhepatic and superior transseptal access are viable alternatives for patients with IVC obstruction.
- Multidisciplinary planning and imaging are key to successful implementation.
