Key result
Electrocautery-assisted transseptal puncture can cause acute intracardiac thrombosis, successfully resolved with prompt heparin.
Why the study?
Electrocautery-assisted transseptal puncture offers clinical advantages but is associated with potential complications.
Case Report (n=1)
No
This report documents the first clinical case of thrombosis during electrocautery-assisted transseptal puncture, highlighting a previously unreported procedural risk and the critical role of intracardiac echocardiography for immediate detection.
Alerts to thrombosis risk with electrocautery-assisted transseptal puncture; leaves open optimal prevention and ICE monitoring strategies.
Electrocautery-assisted transseptal puncture offers clinical advantages but is associated with potential complications. Herein, we describe a case encountered during radiofrequency ablation for atrial fibrillation, in which intracardiac echocardiography detected a thrombus that formed after electrocautery and guidewire traversal of the interatrial septum. The thrombus appeared as a hyperechoic, cord-like structure adherent to the right atrial side of the interatrial septum. Prompt heparin administration led to thrombus resolution without embolization, enabling the procedure to continue safely. This case underscores the thrombotic risk of electrocautery transseptal puncture and highlights the need for further research on optimal anticoagulation strategies.
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Fu et al. (2025) conducted a case report in Atrial Fibrillation (n=1). Electrocautery-assisted transseptal puncture was evaluated. Electrocautery-assisted transseptal puncture caused acute intracardiac thrombosis, which was rapidly detected by intracardiac echocardiography and successfully dissolved with prompt heparin administration.
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