Development of an atrial transseptal puncture procedure in horses to access the left heart: An ultrasound-guided jugular vein and transhepatic approach.

Summary

# Editorial Summary Left-sided cardiac arrhythmias in horses remain difficult to treat because accessing the left atrium via the standard retrograde transarterial route is technically challenging and potentially hazardous. Vernemmen and colleagues adapted the transseptal puncture technique used in human cardiology—specifically, developing an ultrasound-guided method to puncture the atrial septum at the fossa ovalis—but employed a cranial approach via the jugular vein and transhepatic route, which is more practical in equine anatomy. The team successfully performed the procedure on multiple horses, demonstrating the feasibility of this novel access method and establishing the procedural landmarks and technique required for safe needle positioning and septal puncture. This development has significant implications for equine practitioners managing horses with refractory left atrial arrhythmias, as it now opens the possibility of applying radiofrequency ablation therapy to left-sided arrhythmias with potentially less morbidity than current transarterial approaches. The technique represents a meaningful advancement towards expanding interventional cardiac options in equine medicine, though further refinement and validation of long-term safety and efficacy in clinical cases will be essential before widespread adoption.

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Key Findings

• •Transseptal puncture of the fossa ovalis can be performed in horses using ultrasound guidance via jugular vein approach as an alternative to retrograde transarterial access
• •The procedure provides a method to access the left atrium for treatment of left-sided cardiac arrhythmias in horses
• •Technique adaptation from human medicine transfemoral approach to equine jugular vein approach represents a novel procedural development

Conditions Studied

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