Key result
Left internal jugular RFA improves LVEF ~10% and maintains sinus rhythm in a congenital AF case.
Why the study?
Catheter ablation for AF in patients with complex congenital anatomical variants like mirror dextrocardia, interrupted IVC, and PLSVC remains technically challenging with limited published clinical experience.
Case Report (n=1)
No
Catheter ablation for long-standing persistent AF using a left internal jugular approach is feasible and effective in patients with complex congenital anomalies including dextrocardia and interrupted IVC.
Successful ablation feasible in rare dextrocardia with IVC interruption and PLSVC; extends limited case experience but leaves generalizability open.
Catheter ablation is an established treatment for atrial fibrillation (AF). However, AF ablation in patients with complex congenital anatomical variants, including mirror dextrocardia, interrupted inferior vena cava (IVC), and persistent left superior vena cava (PLSVC), remains technically challenging, with limited published clinical experience. We report a 60-year-old female patient with long-standing persistent AF and heart failure with reduced ejection fraction, who had mirror dextrocardia, interrupted IVC, and PLSVC. The procedure was performed via a left internal jugular vein approach for transseptal puncture and ablation. The strategy included bilateral pulmonary vein isolation, linear ablation of the left atrial roof, mitral isthmus, and hepatic venous - tricuspid isthmus, plus electrical isolation of the PLSVC, all guided by intracardiac echocardiography and electroanatomic mapping. At 17 months of follow-up, the patient remained asymptomatic with no documented atrial arrhythmia recurrence. Left ventricular ejection fraction improved from 36% to 46%. This single case demonstrates that in patients with complex anatomical variants and long-standing persistent AF, AF ablation incorporating targeted PLSVC electrical isolation via a left internal jugular vein approach under intracardiac echocardiography guidance is feasible, safe, and clinically effective. Further experience is needed to confirm the generalizability of this strategy.
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Y et al. (2026) conducted a case report in Long-standing persistent atrial fibrillation with heart failure and complex congenital anomalies (mirror dextrocardia, interrupted IVC, mirrored PLSVC) (n=1). Radiofrequency catheter ablation was evaluated on Recurrence of atrial arrhythmias and left ventricular ejection fraction improvement. Radiofrequency ablation via a left internal jugular vein approach successfully maintained sinus rhythm and improved left ventricular ejection fraction from 36% to 46% at 17 months in a patient with long-standing persistent atrial fibrillation and complex congenital anomalies.
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