Key result
Jugular vein transseptal access enables successful pulmonary vein isolation in dextrocardia with interrupted IVC.
Why the study?
Atrial fibrillation ablation in patients with dextrocardia and interrupted inferior vena cava with azygos continuation presents significant technical challenges due to distorted interatrial septal anatomy.
Does an ICE-guided superior approach via the left internal jugular vein allow safe transseptal catheter ablation of atrial fibrillation in a patient with dextrocardia and interrupted inferior vena cava?
Case Report (n=1)
Does an ICE-guided superior approach via the left internal jugular vein allow safe transseptal catheter ablation of atrial fibrillation in a patient with dextrocardia and interrupted inferior vena cava?
An ICE-guided superior approach using the left internal jugular vein and a wire-based transseptal system provides a safe alternative for atrial fibrillation ablation in patients with complex congenital heart disease lacking an inferior route.
May support ICE-guided left IJ transseptal access for AF ablation when IVC route is unavailable; leaves open need for prospective validation.
BACKGROUND: Atrial fibrillation ablation in dextrocardia with interrupted inferior vena cava presents formidable technical challenges, particularly when anomalous systemic venous return distorts interatrial septal relationships. CASE SUMMARY: A 58-year-old man with drug-refractory paroxysmal atrial fibrillation, situs inversus totalis with dextrocardia, and inferior vena cava interruption with azygos continuation to the coronary sinus underwent catheter ablation. Lacking an inferior route, a superior approach through the left internal jugular vein was selected. Under intracardiac echocardiography (ICE) guidance, transseptal access was obtained using a dedicated wire-based system. Pulmonary vein isolation and roofline ablation were safely completed using radiofrequency energy. DISCUSSION: Azygos continuation to the coronary sinus drastically distorts interatrial geometry. ICE-guided, wire-based transseptal access via a superior route is a safe, practical alternative when conventional inferior access is unavailable and needle-based puncture poses high risks. TAKE-HOME MESSAGES: In situs inversus, the left internal jugular vein offers an optimal trajectory for transseptal puncture via a superior approach. Using a dedicated transseptal guidewire instead of a rigid needle, strictly guided by ICE, reduces the risk of mechanical complications during atypical transseptal punctures in complex congenital heart disease.
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Liao et al. (2026) conducted a case report in Drug-refractory paroxysmal atrial fibrillation with dextrocardia, situs inversus totalis, and inferior vena cava interruption (n=1). ICE-guided catheter ablation via a superior approach (left internal jugular vein) with a wire-based transseptal system was evaluated on Procedural success and safety (pulmonary vein isolation and roofline ablation). ICE-guided, wire-based transseptal access via the left internal jugular vein enabled safe and successful pulmonary vein isolation in a patient with dextrocardia and IVC interruption.
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