FIGURE 1.

The shoehorn technique. (A) Left anterior oblique fluoroscopic projection showing a tetrapolar electrode catheter placed in the right subclavian vein for phrenic nerve stimulation and the 12F FlexCath Advance^TM Steerable Sheath showing difficulties for transseptal crossing over a wire placed in the left superior PV. (B) The tetrapolar electrode catheter is introduced then into the LA through the transseptal puncture hole. The shoehorn technique consists of removing back the tetrapolar electrode catheter while we try to progress forward the sheath over the wire placed in the left superior PV. (C) The sheath cross safely the transseptal puncture once the tetrapolar electrode is removed back into the right atrium. LA, left atrium; PV, pulmonary veins.