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Transseptal Puncture Complexity Index (Experimental) Calculator

  • Patient Age (years)
  • Redo TSP / Prior left atrial access
  • Interatrial Septal Occluder / Surgical Patch
  • Interatrial Septum thickness on imaging (mm)
  • Septal aneurysm or lipomatous hypertrophy
  • Thoracic/Anatomic Challenges (choose any)


  • Diabetes mellitus
  • Anticipated largest sheath size (F)
  • Operator experience < 50 TSP procedures
  • Imaging plan
  • RF-enabled needle / electrocautery available
  • Transseptal Puncture Complexity Index (Experimental): Comprehensive Explanation and Clinical Context
    This calculator proposes a pragmatic, literature-informed composite score to anticipate technical complexity of transseptal puncture (TSP) before left atrial procedures. Factors that repeatedly correlate with difficult access include prior TSP or septal instrumentation (e.g., occluder/patch), challenging thoracic or cardiac anatomy, and operator learning curve. Advanced imaging (TEE/ICE) and RF-enabled needles often reduce uncertainty and crossing force requirements. Larger-bore sheaths may increase technical demands and the likelihood of persistent iatrogenic interatrial shunt, which encourages careful site selection and imaging guidance. Because no single validated “Transseptal Puncture Complexity Index” has been universally adopted, this tool is intentionally labeled experimental and should complement—not replace—expert judgment, intraprocedural imaging, and institutional protocols.

    References:
    Russo G, et al. Transseptal puncture: procedural guidance, challenging situations, and complications management. EuroIntervention. 2018.
    O’Brien B, et al. Transseptal puncture—Review of anatomy, techniques and complications. Int J Cardiol. 2017.
    Baykaner T, et al. Safety and efficacy of zero-fluoroscopy transseptal puncture. Heart Rhythm O2 / PMC. 2019.
    Capulzini L, et al. RF energy delivery for challenging TSP. Europace. 2010.
    Hsu JC, et al. Randomized trial comparing TS needles; predictors of transseptal time. JAHA. 2013.
    SCAI QI Tips. Transseptal puncture—Basics and practical considerations. 2023.
    AER Journal Review. Challenging transseptal catheterisations. 2023.
    Azzola Guicciardi N, et al. Transseptal puncture complications: what to watch for and manage. 2025.
    Heil E, et al. Predictors of iatrogenic ASD; role of sheath size and tissue factors. 2025.