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

An interrupted inferior vena cava (I-IVC) is a rare venous malformation, occurring in 0.6% of patients with congenital heart disease and 0.15% of the general population1,2. Pulmonary vein isolation (PVI) of atrial fibrillation (AF) is typically accessed through the femoral vein. However, the presence of an I-IVC requires consideration of alternative routes. Prior reports have described the PVI in patients with an I-IVC using the trans-superior vena cava (SVC), trans-aortic, and trans-hepatic veins, with the superior approach being notably prevalent3–6.