– Zero-fluoro transseptal puncture. After the ICE catheter is positioned in the RA, the LA and SVC are visualized. The guidewire arrives in the SVC, followed by sheath advancement. Sheath position in the SVC is confirmed by saline injection, showing craniocaudal flow. Septal tenting and perforation are shown, followed by wire advancement to the left PV. The sheath is then confirmed in the LA cavity by saline bubble visualization. The second transseptal sheath is then pulled down from the SVC to the septum, followed by a second septal perforation. Access the video here:   