Successful cryoablation of atrial fibrillation from jugular approach in patient with interrupted inferior vena cava and azygos continuation

Kanat, Selçuk; Çakır, Hakan; Tütüncü, Ahmet; Tenekecioğlu, Erhan

doi:10.1111/pace.13540

Cited by 4 publications

(8 citation statements)

References 8 publications

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“…A small number of other cases in the literature with a similar superior approach for AF ablation have shown this approach to be feasible, when necessary. [1][2][3][4][5]8 The IVC is formed from anastomosis of 3 pairs of veins during the fifth to seventh weeks of gestation, with 5 segments contributing to its final structure. 6 Interruption or stenosis of this structure has been found in ,1% of cases in imaging series, and is asymptomatic in cases where the azygos system is well developed, which occurs in roughly half of these.…”

Section: Discussionmentioning

confidence: 99%

“…Pulmonary vein isolation to treat atrial fibrillation (AF) is challenging where the usual femoral route is not possible. [1][2][3][4][5] Interruption of the inferior vena cava (IVC) is a rare anatomic variant, with or without azygos venous system drainage of the lower body into the superior vena cava (SVC). 6,7 This anatomy necessitates an alternative approach for transseptal puncture to allow catheter access to the left atrium, and has been described for both radiofrequency and cryoballoon ablation strategies for AF ablation.…”

Section: Introductionmentioning

confidence: 99%

“…6,7 This anatomy necessitates an alternative approach for transseptal puncture to allow catheter access to the left atrium, and has been described for both radiofrequency and cryoballoon ablation strategies for AF ablation. 2,3,5 We present the first published case of prosthetic material (Dacron) atrial septal defect (ASD) repair puncture, utilizing transjugular access for cryoballoon ablation of AF.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Cryoballoon ablation from above, through a prosthetic patch atrial septal defect repair

Fitzgerald

May

Mahmoodi

et al. 2020

HeartRhythm Case Reports

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Cryoballoon ablation from above, through a prosthetic patch atrial septal defect repair

Fitzgerald

May

Mahmoodi

et al. 2020

HeartRhythm Case Reports

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“…Early reports described manual modifications to the standard transseptal equipment to achieve access. For example, the Brockenbrough needle was often manually bent to 120–150° to provide greater reach and similar angle of entry across the inter‐atrial septum (IAS) 15,17–21 …”

Section: Approaches To Ablation Of Specific Arrhythmiasmentioning

confidence: 99%

Systematic review of electrophysiology procedures in patients with obstruction of the inferior vena cava

Al-Sinan¹,

Cardiac

Chan

et al. 2022

Cardiovasc electrophysiol

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Aims The objective of the study was to conduct a systematic review to describe and compare the different approaches for performing cardiac electrophysiology (EP) procedures in patients with interrupted inferior vena cava (IVC) or equivalent entities causing IVC obstruction. Methods We conducted a structured search to identify manuscripts reporting EP procedures with interrupted IVC or IVC obstruction of any aetiology published up until August 2020. No restrictions were applied in the search strategy. We also included seven local cases that met inclusion criteria. Results The analysis included 142 patients (mean age 48.9 years; 48% female) undergoing 143 procedures. Obstruction of the IVC was not known before the index procedure in 54% of patients. Congenital interruption of IVC was the most frequent cause (80%); and, associated congenital heart disease (CHD) was observed in 43% of patients in this setting. The superior approach for ablation was the most frequently used strategy (52%), followed by inferior approach via the azygos or hemiazygos vein (24%), transhepatic approach (14%), and retroaortic approach (10%). Electroanatomical mapping (58%), use of long sheaths (41%), intracardiac echocardiography (19%), transesophageal echocardiography (15%) and remote controlled magnetic navigation (13%) were used as adjuncts to aid performance. Ablation was successful in 135 of 140 procedures in which outcomes were reported. Major complications were only reported in patients undergoing AF ablation, including two patients with pericardial effusion, one of whom required surgical repair, and another patient who died after inadvertent entry into an undiagnosed atrioesophageal fistula from a previous procedure. Conclusion The superior approach is most frequent approach for performing EP procedures in the setting of obstructed IVC. Transhepatic approach is a feasible alternative, and may provide a “familiar approach” for transseptal access when it is required. Adjunctive use of long sheaths, intravascular echocardiography, electro‐anatomical mapping and remote magnetic navigation may be helpful, especially if there is associated complex CHD. With careful planning, EP procedures can usually be successfully performed with a low risk of complications.

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“…IVC hypoplasia, an alternative technique and vascular access are required. It has been reported that trans-jugular vein access is feasible for catheter ablation of AF, with both technology (cryoballoon and radiofrequency) [2][3][4][5][6] . We report successful cryoablation of paroxysmal AF via RIJV in a patient with hypoplasia of IVC.…”

Section: Introductionmentioning

confidence: 99%

Successful catheter ablation of atrial fibrillation from superior venous approach.

Gionti

Lenti

Negro

et al. 2020

Preprint

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Background: Trans-catheter ablation of drug refractory atrial fibrillation (AF) is an effective and safe treatment to avoid arrhythmia recurrences. However, some patients may present anatomic variant making impossible an inferior venous approach. We report a case of pulmonary veins isolation (PVI) with cryoballoon technology via right internal jugular vein (RIJV) access. Methods: After the first trans catheter PVI attempt was failed due to inferior vena cava (IVC) hypoplasia, cryoballoon ablation with a 28-mm cryoballoon (AFAPRO-Medtronic CryoCath LP, Quebec, Canada) via superior venous access was performed. A quadripolar electrode was inserted in coronary sinus from left basilic vein. The right internal jugular vein was accessed with Seldinger technique and left atrial (LA) catheterization was performed via single trans-septal puncture (TP) under transesophageal echocardiographic (TOE) and fluoroscopy guidance using an SL2 (St. Jude Medical) trans-septal sheath with a BRK2 (St. Jude Medical) needle. All pulmonary veins (PVs) were engaged. Cryothermal energy was delivered after checking the correct occlusion and PVI was successfully obtained for all PVs. The procedure lasted 210 min, fluoroscopy time was 55 min. During the 16-month follow-up no sustained atrial arrhythmia recurrence was detected. Conclusion: PVI with cryoballoon technology in patients with hypoplasia of IVC can be safely and successfully performed using right internal jugular access.

show abstract

Successful cryoablation of atrial fibrillation from jugular approach in patient with interrupted inferior vena cava and azygos continuation

Cited by 4 publications

References 8 publications

Cryoballoon ablation from above, through a prosthetic patch atrial septal defect repair

Cryoballoon ablation from above, through a prosthetic patch atrial septal defect repair

Systematic review of electrophysiology procedures in patients with obstruction of the inferior vena cava

Successful catheter ablation of atrial fibrillation from superior venous approach.

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