Solving difficulties in transseptal sheath crossing: the shoehorn technique.

Transseptal sheath crossing sometimes can be challenging. We present the shoehorn technique to solve this situation. This maneuver consists of removing back a tetrapolar electrode previously placed in the left atrium through the transseptal puncture hole while we try to progress the sheath through it as well, expanding the hole and permitting the sheath to cross safely the transseptal puncture.