Key result
Novel cross-over cryoballoon posterior wall isolation maintains 48-month AF freedom in dextrocardia.
Why the study?
Catheter ablation of AF in situs inversus with dextrocardia poses technical challenges, and previous cryoballoon LAPWI required adjunctive radiofrequency ablation to achieve complete isolation.
Case Report (n=1)
No
Complete left atrial posterior wall isolation using cryoballoon ablation alone with the cross-over technique is feasible and effective in patients with situs inversus with dextrocardia.
Supports cryoballoon posterior wall isolation feasibility in dextrocardia; hypothesis-generating and leaves generalizability open.
Background Situs inversus with dextrocardia (SID) is a rare congenital condition with fully mirrored cardiac anatomy, posing unique technical challenges for catheter ablation of atrial fibrillation (AF). Although cryoballoon (CB)-based left atrial posterior wall isolation (LAPWI) has recently been reported in a patient with SID, adjunctive radiofrequency catheter ablation was required to complete posterior wall isolation. We present a case in which complete LAPWI was achieved exclusively using CB applications with the previously described cross-over technique. Case summary A 69-year-old woman with SID and drug-refractory persistent AF underwent catheter ablation using a fourth-generation CB system. To accommodate mirrored anatomy, the procedure was performed using mirror-image fluoroscopy and intentionally reversed catheter manipulation to restore conventional spatial orientation. Pulmonary vein isolation was achieved, followed by LAPWI using the cross-over technique, in which overlapping CB applications were delivered from both left- and right-sided pulmonary vein anchor positions to improve lesion continuity across the left atrial posterior wall. Complete LAPWI was confirmed by voltage mapping and pacing maneuvers demonstrating both entrance and exit block. No periprocedural complications occurred. The patient remained free from AF recurrence for 48 months without antiarrhythmic therapy. Discussion This case demonstrates that complete CB-based LAPWI using the cross-over technique is feasible even in anatomically mirrored hearts. The successful use of mirror-image fluoroscopy and intentionally reversed catheter manipulation provides practical technical insights and highlights the importance of deliberate spatial adaptation when performing complex left atrial ablation in patients with SID.
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Odagiri et al. (2026) conducted a case report in Situs inversus with dextrocardia and drug-refractory persistent atrial fibrillation (n=1). Cryoballoon left atrial posterior wall isolation using the cross-over technique was evaluated on Freedom from atrial fibrillation recurrence. Cryoballoon left atrial posterior wall isolation using the cross-over technique successfully treated persistent atrial fibrillation in a patient with dextrocardia, with no recurrence at 48 months.
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