title: The use of balloon atrial septostomy to facilitate difficult transseptal access in patients undergoing catheter ablation for atrial fibrillation.
abstract: BACKGROUND
  With the increasing number of patients undergoing repeat catheter ablation procedures for atrial fibrillation, it is not uncommon to encounter a fibrotic interatrial septum that resists the conventional manual advancement of the transseptal sheath. Forceful advancement of the transseptal apparatus can reduce fine control and potentially lead to a higher rate of perforation.
  
  
  METHODS
  We report a case where adjunctive balloon atrial septostomy was used to facilitate transseptal access in a patient with fibrotic interatrial septum. Using a small-caliber angioplasty balloon and under direct fluoroscopic and transesophageal echocardiogram visualization, balloon septostomy was performed with hand inflation until a "waist" was seen. This technique provides a safe way to control the size of the transseptal access created, and allows the passage of a relatively soft-tipped transseptal sheath across a resistive septum. To our knowledge this is the first published use of balloon atrial septostomy during transseptal puncture for left atrium access in a catheter ablation procedure.
  
  
  CONCLUSIONS
  Balloon atrial septostomy should be considered as an alternative technique for safe transseptal cannulation in select patients in the electrophysiology laboratory or other interventional procedures requiring left atrial access or delivery of large-caliber catheters or sheaths.
authors.affiliation: Department of Cardiology, Good Samaritan Hospital, Los Angeles, California 90017, USA.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Zadeh
authors.forename: David S
authors.initials: DS
authors.lastname: Cannom
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Macrum
authors.forename: Ivan C
authors.initials: IC
authors.lastname: Ho
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000628:therapy*; D054087:Atrial Septum / Q000502:physiology; D017115:Catheter Ablation; D006801:Humans; D008297:Male; D008875:Middle Aged