Thrombosis occurring during transseptal puncture with electrocautery: A case report

Xiaohong Fu; Jia Gao; Min Guo; Meng Sun; Nan Zhang; Rui Wang

doi:10.1016/j.hroo.2025.10.004

Thrombosis occurring during transseptal puncture with electrocautery: A case report

Heart Rhythm O2. 2025 Oct 14;7(1):183-187. doi: 10.1016/j.hroo.2025.10.004. eCollection 2026 Jan.

Authors

Xiaohong Fu¹, Jia Gao¹, Min Guo¹, Meng Sun¹, Nan Zhang¹, Rui Wang¹

Affiliation

¹ Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China.

Abstract

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.

Keywords: Anticoagulation; Atrial fibrillation; Electrocautery; Thrombosis; Transseptal puncture.

Publication types

Editorial