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. 2024 Apr 8;26(4):euae043. doi: 10.1093/europace/euae043

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This article has been co-published with permission in Europace, HeartRhythm, Journal of Arrhythmia and Journal of Interventional Cardiac Electrophysiology. © 2024 Heart Rhythm Society, the European Society of Cardiology, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society The articles are identical except for minor stylistic and spelling differences in keeping with each journal's style. Any citation can be used when citing this article.

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited.

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Anatomic variations of the interatrial septum that may be encountered during transseptal puncture. (A) Patent foramen ovale (white arrow); (B) septal aneurysm with large excursion towards the right atrium (white arrow); (C) tenting of floppy septum from transseptal needle close to the left atrial wall; (D) very small fossa ovalis (white arrow) in a patient with lipomatous septal hypertrophy (yellow arrow); (E) standard transseptal needle crossing a pericardial patch; (F) atrial septal closure device (yellow arrow) covering almost all of the interatrial septum. LA, left atrium.