Successful transseptal puncture and cryoballoon ablation of symptomatic paroxysmal atrial fibrillation via jugular access in a patient with bilateral thrombotic femoral vein occlusion

Figures

• 

  Figure 1. A: The decapolar diagnostic catheter placed in the coronary sinus, and the deflectable (Agilis-L, Abbott, Chicago, IL) sheath placed in the inferior vena cava over the wire (the shadow below the coronary sinus catheter is the tissue on the surface). B: Under transesophageal echocardiography the sheath was deflected and pulled back until the tenting of the interatrial septum occurred. C: Transseptal punction with the long XS BRK1 needle (Abbott). D, E: Positioning of the sheath in the left inferior pulmonary vein for the angiography (shown in Figure 2) and for the cryo-sheath exchange. F: The cryo-sheath placed in the left superior pulmonary vein.

• 

  Figure 2. A: The diagnostic catheter placed in the right ventricle for the rapid pacing (S1 300 ms). The angiography was performed manually using the 50 mL syringe with the pure contrast medium. B: Schematic illustration of the left atrium and the ostia of the pulmonary veins in this case. LIPV = left inferior pulmonary vein; LSPV = left superior pulmonary vein; RIPV = right inferior pulmonary vein; RSPV = right superior pulmonary vein.

• 

  Figure 3. The angiographic and schematic illustration of the cryoballoon position during the application in all pulmonary veins (PV). A: The cryoballoon is placed in the right superior PV using the loop technique. B: The cryoballoon placed in the left superior PV. C: The cryoballoon is placed in the right inferior PV using the loop technique. D: The cryoballoon is placed into the left inferior PV (the “pull up” maneuver was used during this application).