ABSTRACT
Femoral artery and vein are common sites of entry for catheterization of right and left heart chambers for electrophysiologic recordings. This chapter discusses femoral vein puncture, femoral artery puncture, subclavian vein puncture, and internal jugular vein puncture. Femoral artery puncture is performed lateral to the femoral vein puncture sites just below the inguinal ligament. Many centers perform catheter ablation in patients on warfarin with therapeutic international normalized ratio. Additionally, intravenous infusion of heparin is given to maintain an activated clotting time of over 300 s for procedures that necessitate left atrial instrumentation. The coronary sinus allows recording of left atrial and ventricular electrograms. The availability of wide range of multi-polar catheters including steerable catheters makes venous access flexible. A quadripolar steerable or fixed-curve catheter is used for His bundle recording. This is advanced from the femoral vein to the superior tricuspid annulus, around 1 to 2 o’clock in the left anterior oblique fluoroscopic view.
