Provocative Cases -> Teaching Case Reports D-PO03 - Poster Session III (ID 48) Poster

D-PO03-063 - The Shoehorn Transseptal: Catheter Use Facilitates Challenging Transseptal Punctures (ID 300)


Background: A challenging interatrial septum (IAS) may limit the ability to successfully perform transseptal puncture (TSP). Using a deflectable catheter (DC) to facilitate septal crossing, the “catheter shoehorn technique” (CST) can facilitate difficult TSP.
Objective: We present a case series of patients undergoing AF ablation who required the CST to safely and successfully advance a long sheath across the IAS.
Results: At our center from 2014-2019, the CST was used for TSP in 10 patients to facilitate AF ablation. In each case, TSP was achieved with dilator and wire, but the associated long sheath (SL1 or Agilis) could not be advanced over these structures. A decapolar DC was then used to engage the TSP site immediately adjacent to the structures that had already been successfully advanced (figure, A1 & B1). The DC was then maneuvered such that its distal tip was advanced through the TSP site (figure, A2 & B2). In a simultaneous motion the DC was withdrawn as forward pressure was applied to the sheath over dilator and wire, which allowed the sheath to slide into the left atrium (figure, A3 & B3). Reasons for difficult TSP included prior atrial septal defect repair (n=1), prior septostomy for mitral valve replacement (n =1), thick (n=2) or aneurysmal (n=1) IAS, and prior TSP (n=5). In 6 cases double TSP was successfully performed, and in 4 cases catheter ablation was done via a single TSP. No complications occurred.
Conclusion: We report a case series of 10 patients who underwent a novel catheter shoehorn technique to successfully negotiate complex interatrial anatomy during TSP.