Clinical & Medical Case Reports in Cardiology

Background: A transseptal puncture is one of the most challenging parts of advanced cardiac procedures for both electrophysiologists and interventional cardiologists. There are numerous complications that have been reported before, but there is no information about the puncture of descendent aorta. Here, we present the puncture of descendent aorta in a patient on dabigatran therapy. Patient & Result: A 62-year-old woman was admitted because of frequent palpitations. She was diagnosed with hypertension, paroxysmal atrial fibrillation (AFib), complete atrioventricular block and DDDR pacemaker (PM) was implanted two years ago. Because of numerous AFib episodes and amiodarone therapy, we decided to isolate pulmonary veins. She was on dabigatran therapy. Echocardiography showed normal atriums with patent foramen ovale and mild depression of left ventricular functions. During transseptal access, descending aorta was punctured as a result of mainly inexperienced operator and other factors. It was confirmed by course of guidewire in aorta and blood pressure through the needle. Also, thrill on descending aorta was clearly felt over the proximal part of transseptal needle and measured blood pressure over the needle was 185/110 mm Hg. Finally, an injected contrast agent through the SLO dilatator seen in the lumen of descendent aorta and both in media and adventitia part of its wall 2x2.5 mg of idarucizumab was injected in order to reverse the effect of dabigatran. A transseptal set was left in descendant aorta for 60 minutes and we slowly pulled it back to the left atrium. There was no occurrence of any adverse outcome. Conclusion: To our best knowledge, this is the first case report regarding to the puncture of descending aorta on dabigatran therapy. Also, it includes an invaluable experience for both interventional cardiologists and electrophysiologists.