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Since the first direct left atrial pressure recording in a patient with an atrial septal defect by Cournand et al.,1 different approaches such as the transbronchial2 and percutaneous apical left ventricle puncture3 methods have been used for obtaining the pressure of the left cardiac chamber in order to treat patients with various heart diseases. The current transseptal catheterization was first performed by Ross et al .,4 and the technique underwent several modifications since then, to meet the specific needs.5-7 Transseptal catheterization has been used for diagnostic purposes in valvular heart disease, however with the development of new non-invasive technologies such as 2-dimentional (D) echo/Doppler and cardiac MRI, the need for transseptal catheterization has greatly decreased since early 1990. The interest in the transseptal catheterization was revived by interventional cardiology in order to meet the needs of the new percutaneous therapeutic procedures such as mitral and aortic valvuloplasty, closure of atrial septal defects, left atrial appendage occlusion, and the recent mitral annuloplasty. Transseptal catheterization was also revived by the interventional electrophysiology field and has been used to treat a variety of arrhythmias including left sided accessory pathways,8 left atrial or pulmonary vein origin atrial tachycardias,9, 10 atrial fibrillation,11 and ventricular tachycardia.12 Thus, the transseptal catheterization technique was further modified in a unique way, and currently several transseptal techniques have been reported in the literature.13-17 With the recent advances in atrial fibrillation ablation, the double transseptal catheterization technique has become the cornerstone of atrial fibrillation ablation. Therefore, a proper transseptal catheterization is essential for a successful left atrial or ventricular arrhythmia ablation. This article intended to review some of the important considerations for transseptal catheterization in the cardiac electrophysiology practice for patients with left atrial and ventricular arrhythmias.
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