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Figure 1 Fluoroscopic images demonstrating the method for transatrial pericardial access. (A) The 8-F guide catheter (arrows) rests against the wall of the right atrial appendage. (B) The needle catheter (arrow) is protruding through the wall of the right atrial appendage into the pericardial space. (C) The guide wire (arrows) has been advanced through the needle catheter into the pericardial space. (D) The 4-F delivery catheter (arrows) has been advanced over the wire through the appendage wall and positioned in the pericardial space.