Key result
An alternative superior approach for transseptal puncture allows cryoballoon ablation for atrial fibrillation in patients with an interrupted inferior vena cava and prosthetic patch ASD repair.
Why the study?
Pulmonary vein isolation to treat AF is challenging when inferior vena cava interruption precludes the usual femoral route, necessitating an alternative approach for transseptal puncture.
Case Report
Describes an alternative superior approach for cryoballoon ablation of atrial fibrillation in patients with interrupted inferior vena cava and a prosthetic atrial septal defect patch.
May enable cryoballoon ablation in rare venous anomalies; hypothesis-generating and should not yet change practice.
Pulmonary vein isolation to treat atrial fibrillation (AF) is challenging where the usual femoral route is not possible.1–5 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.
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Fitzgerald et al. (2020) conducted a case report in Atrial fibrillation with interrupted inferior vena cava. Cryoballoon ablation from above through a prosthetic patch atrial septal defect repair was evaluated. An alternative superior approach for transseptal puncture allows cryoballoon ablation for atrial fibrillation in patients with an interrupted inferior vena cava and prosthetic patch ASD repair.
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