Clinical implications
Transseptal access is the key step in radiation-reducing strategies for CA of left-sided arrhythmias. Our data suggests that an entirely ICE-guided TSP enables operators to achieve completely fluoroless ablation procedures without compromising safety and efficacy. Fluoroscopy-based studies report, albeit rarely, complications such as right atrial wall puncture, aortic root puncture and embolisms which were not detected in the present study (1,2,18). Routine use of ICE does not only provide real time visualization of IAS anatomy relevant to TSP but also facilitates early recognition of potential procedural complications such as formation of thrombus, signs of impending steam pop or pericardial effusion. In our study we had two aborted cases due to early recognition of thrombus with ICE which in theory prevented an adverse event.