Catheter ablation of atrial fibrillation via retrograde aortic approach in a patient with interrupted inferior vena cava: a case report

Abstract

Radiofrequency catheter ablation (RFCA) is a cornerstone treatment of atrial fibrillation (AF). Transfemoral venous approach with transseptal puncture to assess left atrium (LA) is a mainstream method for AF ablation. Interrupted inferior vena cava (IVC) is a rare congenital vascular anomaly which complicates electrophysiologic procedures and makes conventional approach not feasible. According to previous literature, trans-jugular and transhepatic approach were two alternative methods to achieve AF ablation. Difficulty in transseptal puncture and bleeding risk were still the major concern of these alternative approach. This report presents a 55-year-old female with an incidental finding of interrupted IVC during AF ablation. Retrograde aortic approach was applied to assess LA for RFCA according to our previous experience. Circumferential pulmonary vein isolation was achieved and confirmed by absence of pulmonary vein potentials using the ablation catheter. After the procedure, no adverse events were observed. Neither recurrence of atrial tachyarrhythmia nor valvular injury was observed during oneyear follow-up period.A 55-year-old female patient was referred to our cardiovascular clinic from primary care hospital for propafenone refractory paroxysmal AF for two years. Because of intolerable symptoms, RFCA was suggested. The hemogram, comprehensive biochemical panel, and thyroid function test were reported normal. The echocardiogram revealed normal left ventricular systolic function without structural heart disease. After careful discussion of

Back flip technique for pulmonary vein isolation: A case of radiofrequency ablation for paroxysmal atrial fibrillation in a patient with dextrocardia, situs inversus, and interrupted inferior vena cava

“…Several reports have detailed the catheter ablation of AF in patients with an I-IVC. Various alternative routes to access the LA exist, including via the transaortic 5 , 6 and transhepatic veins. 8 , 9 Nonetheless, a superior approach is relatively common.…”

“… 4 With the transaortic route, maneuvering the catheter into the LA is technically demanding. While successful PVI has been documented, 6 others have reported difficulty in delivering the catheter to the right inferior PV even with a magnetic navigation system. 5 The limitations of the transaortic PVI with a magnetic navigation system include a scarcity of institutions that have access to such equipment and the necessity for an arterial puncture.…”

“…Prior reports have described the PVI in patients with an I-IVC using the trans–superior vena cava (SVC), transaortic, and transhepatic veins, with the superior approach being notably prevalent. 3 , 4 , 5 , 6 The standard superior approach can complicate the catheter manipulation within the left atrium (LA), often necessitating a specific adjustment of both the puncture site and puncture device. 4 …”