Transseptal Puncture for Left Atrial Appendage Closure: A Consensus Document From the Second European Left Atrial Appendage Club

Transseptal puncture (TSP) is a critical step in left atrial appendage closure. This consensus document reviews the evolution of TSP techniques and instrumentation, comparing conventional mechanical methods with radiofrequency-assisted approaches. It highlights the importance of imaging-based preplanning with transoesophageal echocardiography and multislice computed tomography to optimize TSP positioning and procedural outcomes. The inferoposterior fossa ovalis position is generally preferred to achieve coaxial device alignment and enhance safety and efficacy, whereas alternative TSP positions may suit better specific complex anatomies. Procedural guidance under transoesophageal echocardiography and intracardiac echocardiography-guidedosto TSP is illustrated, and a stepwise strategy for challenging cases is outlined. We propose an algorithm for TSP preplanning and intraprocedural guidance, along with expert consensus recommendations developed during the second European Left Atrial Appendage Club meeting.