Transseptal Puncture for Left Atrial Appendage Closure: A Consensus Document From the Second European Left Atrial...

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Device Technology

Background:

• Transseptal puncture (TSP) is an essential procedure for left atrial appendage closure.
• Evolution of TSP techniques includes mechanical and radiofrequency-assisted methods.
• Optimal positioning and guidance are crucial for procedural success.

Purpose of the Study:

• To review the evolution of transseptal puncture techniques and instrumentation.
• To compare conventional mechanical and radiofrequency-assisted TSP approaches.
• To provide expert consensus recommendations for TSP preplanning and guidance.

Main Methods:

• Review of current literature on transseptal puncture techniques.
• Comparison of conventional mechanical versus radiofrequency-assisted methods.
• Emphasis on imaging modalities like transoesophageal echocardiography and multislice computed tomography for preplanning.

Main Results:

• The inferoposterior fossa ovalis position is generally preferred for coaxial alignment, safety, and efficacy.
• Alternative TSP positions may be necessary for complex anatomies.
• Imaging-based preplanning and procedural guidance (TEE, ICE) are highlighted.

Conclusions:

• A consensus algorithm for TSP preplanning and intraprocedural guidance is proposed.
• Expert recommendations aim to optimize TSP positioning and procedural outcomes.
• The inferoposterior fossa ovalis remains the preferred TSP site, with tailored approaches for complex cases.