Successful Transseptal Puncture Through Tortuous Inferior Vena Cava with a Novel Transseptal Guidewire: a case report

Background Atrial transseptal puncture is a fundamental maneuver in transseptal transcatheter interventions, and inferior vena cava tortuosity could cause failure of conventional transseptal puncture method with Brockenbrough (BRK) needle. Case summary We report a rare case of inferior vena cava tortuosity in a patient with atrial fibrillation in which the conventional transseptal puncture method failed due to marked needle deformation, and was completed by a novel transseptal wire (AccuSafe™, Synaptic Medical) in combination with a steerable sheath. Discussion Inferior vena cava tortuosity is one of the major causes of unsuccessful atrial transseptal puncture, even under the guidance of intracardiac echocardiography. The new transseptal wire should be the initial selection rather than a conventional transseptal needle when encountering severe inferior vena cava tortuosity.