Catheter ablation of atrial fibrillation via superior approach in patients with interruption of the inferior vena cava

Abstract

Percutaneous transcatheter ablation of atrial fibrillation (AF) in patients with interruption of inferior vena cava (IVC) has not been reported in the literature. The purpose of this article was to demonstrate the safety and feasibility of the superior approach via the right internal jugular vein in performing catheter ablation of AF. We performed AF ablation in 3 patients (mean age: 51.7 +/- 18.5 years, 2 paroxysmal AF and 1 persistent AF) with complete interruption of IVC. Transseptal puncture was performed via the right internal jugular vein with a long sheath and manually curved Brockenbrough needle to facilitate the tip downward to the FO. Three-dimensional (3D) mapping was performed in 2 patients. Electrical isolation of each pulmonary vein (PV) was confirmed by a circular mapping catheter. Bidirectional block at the RA isthmus was achieved in 1 patient with clinically documented typical atrial flutter. In all patients, AF ablation after transseptal puncture via the superior approach was successfully performed without complications. Selective PV isolation of arrhythmogenic PV was done in 1 patient, and circumferential bilateral antral ablations were done in 2 patients. In 1 patient with persistent AF, linear ablations of left atrial roof and perimitral and RA isthmus were done after electrical isolation of all PVs. At a mean follow-up of 18.7 +/- 15.5 months, arrhythmias were free without any antiarrhythmic drugs in all patients. AF ablation via the superior approach is a safe and feasible alternative technique when a femoral venous approach is not available.