Key result
Radiofrequency ablation of atrial fibrillation via a superior transseptal approach was safely and effectively performed without fluoroscopy in a patient with dextrocardia and interrupted inferior vena cava.
Why the study?
Dextrocardia with interruption of the inferior vena cava is a rare anatomical variant that makes catheter ablation of AF challenging for electrophysiologists.
Case Report (n=1)
Demonstrates the feasibility and safety of a fluoroscopy-free, superior transseptal approach for radiofrequency ablation of atrial fibrillation in a patient with complex venous anomalies.
Answers are grounded in this paper and cite their sources.
Demonstrates feasibility of radiation-free superior transseptal ablation in this rare anatomy; leaves open generalizability pending larger series.
BACKGROUND: Dextrocardia with interruption of the inferior vena cava (I-IVC) is a very rare anatomical variant. Catheter ablation of atrial fibrillation (AF) in patients with this anatomical variant is challenging for electrophysiologists. This case report presents a safe, effective, and radiation-free approach for high-power ablation of AF via a superior transseptal approach in patients with dextrocardia and I-IVC. CASE SUMMARY: A 57-year-old man with paroxysmal AF with dextrocardia and I-IVC with azygos continuation was referred to our hospital for radiofrequency (RF) ablation. It was evident that transseptal puncture and pulmonary vein isolation (PVI) would be impossible using an IVC approach via the femoral vein. Therefore, we decided to perform left atrium (LA) ablation via the superior vena cava approach. A phased array intracardiac echocardiography (ICE) catheter was inserted in the right femoral vein. Three-dimensional (3D) anatomical reconstruction of LA, right atrium (RA), and coronary sinus (CS) ostium were performed using ICE with azygos vein and RA imaging. Navigation-enabled electrodes were inserted into annotated CS on cardiac 3D ICE image. The left internal jugular vein was accessed using an SL1 transseptal sheath and Brockenbrough needle. Transseptal puncture was performed under ICE with an RF-assisted approach. We accomplished ablation index guided high-power pulmonary vein isolation using a bi-directional guiding sheath with visualization capabilities and a surround flow contact force-sensing catheter. No complications occurred during or after the procedure. DISCUSSION: With the application of multitude of newer technologies, we can accomplish safe, effective, and fluoroscopy-free RF ablation of AF using the superior approach in patients with complex anomaly.
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Wu et al. (2021) conducted a case report in Paroxysmal atrial fibrillation with dextrocardia and interruption of the inferior vena cava (n=1). Radiofrequency ablation via a superior transseptal approach was evaluated on Procedural success and complications. Radiofrequency ablation of atrial fibrillation via a superior transseptal approach was safely and effectively performed without fluoroscopy in a patient with dextrocardia and interrupted inferior vena cava.
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