Successful slow pathway modification with radiofrequency ablation in a patient with AVNRT and congenital IVC continuity with azygos vein

Background: Congenital anomalies of the inferior vena cava (IVC), such as interrupted or azygos continuation, complicate catheter-based procedures like atrioventricular nodal reentrant tachycardia (AVNRT) ablation. Understanding IVC variations is crucial for successful outcomes in interventional cardiology. Case presentation: A 57-year-old male with long-standing paroxysmal atrial fibrillation (AF) underwent successful catheter ablation for AVNRT. Intra-procedurally, a congenital IVC anomaly was identified, requiring modified vascular access. Conclusion: Recognizing IVC anomalies and adapting access strategies are key to overcoming procedural challenges and ensuring successful ablation outcomes. Comprehensive imaging and planning are vital for managing patients with IVC variations. LEARNING POINTS: Congenital inferior vena cava (IVC) anomalies, including azygos continuation, can complicate catheter-based interventions such as ablation of atrioventricular nodal reentrant tachycardia.Congenital anomalies of IVC are rare but critical considerations for atrioventricular nodal reentry tachycardia (AVNRT) ablation procedures.Understanding these variations is essential for ensuring successful catheter-based interventions and minimizing the risk of complications.