Why the study?
Standard inferior vena cava access for radiofrequency catheter ablation of atrial fibrillation may not be feasible in patients with heterotaxy syndrome.
Is percutaneous transhepatic access for catheter ablation feasible and safe in a patient with heterotaxy syndrome and atrial fibrillation?
Is percutaneous transhepatic access for catheter ablation feasible and safe in a patient with heterotaxy syndrome and atrial fibrillation?
In patients without femoral vein access, such as those with heterotaxy syndrome, percutaneous transhepatic access is a viable and safe alternative for pulmonary vein isolation.
Alternative access enables AF ablation in heterotaxy; leaves open safety, durability, and generalizability pending larger studies.
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.
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Wang et al. (2022) studied this question.
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