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BACKGROUND Atrial fibrillation (AF) is one of the most common arrhythmias, and radiofrequency catheter ablation is the most effective treatment strategy. The inferior vena cava (IVC) is a common approach for radiofrequency ablation of AF. However, this approach may not be applied to some cases such as chronic venous occlusions, surgical ligation of the IVC, and heterotaxy syndrome (HS). CASE SUMMARY A 68-year-old man with HS suffered from severely symptomatic persistent AF for 9 years, and we successfully ablated by percutaneous transhepatic access. CONCLUSION In patients without femoral vein access, the use of the hepatic vein for pulmonary vein isolation is a viable alternative for invasive electrophysiology procedures.

We describe a sketch-based system for modeling 3D shapes based on a new multiresolution shape representation we call a layered mesh. Like subdivision surfaces, layered meshes provide a multiresolution hierarchy of meshes. A key difference is that a layered mesh lets you edit the shape and structure of the mesh at any level of the hierarchy, through the notion of shape primitives organized in a dependency network. The simplest primitives are points and curves, which can be used to define several kinds of parameteric surface. Surfaces can be inflated or smoothly joined to produce a broad range of shapes. An important feature of the system is the ability to refine shapes and add detail by oversketching primitives, either directly or via the curves that define them. While our user interface is still in development, our initial results show the potential for this approach.

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