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Wang HX, Li N, An J, Han XB. Percutaneous transhepatic access for catheter ablation of a patient with heterotaxy syndrome complicated with atrial fibrillation: A case report. World J Clin Cases 2022; 10:7006-7012. [PMID: 36051120 PMCID: PMC9297398 DOI: 10.12998/wjcc.v10.i20.7006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 04/14/2022] [Accepted: 05/22/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is one of the most common arrhythmias, and radiofrequency catheter ablation is the most effective treatment strategy. The inferior vena cava (IVC) is a common approach for radiofrequency ablation of AF. However, this approach may not be applied to some cases such as chronic venous occlusions, surgical ligation of the IVC, and heterotaxy syndrome (HS).
CASE SUMMARY A 68-year-old man with HS suffered from severely symptomatic persistent AF for 9 years, and we successfully ablated by percutaneous transhepatic access.
CONCLUSION In patients without femoral vein access, the use of the hepatic vein for pulmonary vein isolation is a viable alternative for invasive electrophysiology procedures.
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Affiliation(s)
- Hai-Xiong Wang
- Department of Cardiology, Shanxi Cardiovascular Hospital, Taiyuan 030000, Shanxi Province, China
| | - Na Li
- Department of Cardiology, Shanxi Cardiovascular Hospital, Taiyuan 030000, Shanxi Province, China
| | - Jian An
- Department of Cardiology, Shanxi Cardiovascular Hospital, Taiyuan 030000, Shanxi Province, China
| | - Xue-Bin Han
- Department of Cardiology, Shanxi Cardiovascular Hospital, Taiyuan 030000, Shanxi Province, China
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2
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Kupics K, Jubele K, Nesterovics G, Erglis A. A case report of pulmonary vein isolation performed in a patient with polysplenia and interrupted inferior vena cava. Eur Heart J Case Rep 2021; 5:ytab480. [PMID: 34909574 PMCID: PMC8665676 DOI: 10.1093/ehjcr/ytab480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/18/2021] [Accepted: 11/15/2021] [Indexed: 11/15/2022]
Abstract
Background Pulmonary vein isolation (PVI) has entrenched itself as one of the main approaches for the treatment of paroxysmal symptomatic atrial fibrillation (AF). Pulmonary vein isolation prevents focal triggers from pulmonary veins from initiating AF paroxysms. As standard—PVI is performed through the inferior vena cava (IVC) approach, through the femoral vein. However, there are conditions when this approach is not appropriate or is not available. Case summary We report a case of a 53-year-old male who was referred to Pauls Stradins Clinical University Hospital for PVI due to worsening AF. Due to the rare anatomical variant of the venous system, the standard approach to PVI could not be applied. Interrupted cava inferior did not allow for femoral vein and IVC access. We had to figure out a different path—a combination of internal jugular and subclavian veins was used. Transseptal puncture was performed under transoesophageal echocardiography (TOE) control with a puncture needle stiletto. Pulmonary veins were isolated successfully, no complications were observed, and the patient was discharged in sinus rhythm. Discussion In some patients, PVI cannot be done through the standard IVC approach. In such cases, a different venous access must be chosen. Our patient had a rare variant of interrupted IVC and we had to use superior vena cava approach for the procedure. The difficulty of this approach is that procedure instruments are not designed for non-standard venous access; however, a combined use of TOE, general anaesthesia, and contact force-guided ablation has succeeded in isolating patients’ pulmonary veins.
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Affiliation(s)
- Kaspars Kupics
- Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Pilsonu iela 13, Riga LV-1002, Latvia
- Faculty of Medicine, University of Latvia, Jelgavas iela 3, Riga LV-1004, Latvia
| | - Kristine Jubele
- Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Pilsonu iela 13, Riga LV-1002, Latvia
- Faculty of Medicine, Riga Stradins University, Dzirciema iela 16, Riga LV-1007, Latvia
| | - Georgijs Nesterovics
- Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Pilsonu iela 13, Riga LV-1002, Latvia
- Faculty of Medicine, University of Latvia, Jelgavas iela 3, Riga LV-1004, Latvia
| | - Andrejs Erglis
- Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Pilsonu iela 13, Riga LV-1002, Latvia
- Faculty of Medicine, University of Latvia, Jelgavas iela 3, Riga LV-1004, Latvia
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3
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Masumoto A, Kobori A, Sasaki Y, Pak M, Furukawa Y. Successful catheter ablation of persistent atrial fibrillation and common atrial flutter in a patient with dextrocardia, situs inversus, and interrupted inferior vena cava with azygos continuation. HeartRhythm Case Rep 2021; 7:403-407. [PMID: 34194990 PMCID: PMC8226307 DOI: 10.1016/j.hrcr.2021.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Akiko Masumoto
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku, Kobe, 6500047, Japan
| | - Atsushi Kobori
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku, Kobe, 6500047, Japan
| | - Yasuhiro Sasaki
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku, Kobe, 6500047, Japan
| | - Mison Pak
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku, Kobe, 6500047, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku, Kobe, 6500047, Japan
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4
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Ernst S, Samchkuashvili N, Kadiwar S, Barton B, Nienaber C, Till J. Peripheral vascular access for catheter ablation of supraventricular tachycardia using remote magnetic navigation. HeartRhythm Case Rep 2021; 7:351-353. [PMID: 34194977 PMCID: PMC8226276 DOI: 10.1016/j.hrcr.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Sabine Ernst
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College, London, United Kingdom
- Address reprint requests and correspondence: Dr Sabine Ernst, Professor of Practice (Cardiology), Consultant Cardiologist/Electrophysiologist, National Heart and Lung Institute, Imperial College, Royal Brompton and Harefield Hospital, Sydney St, SW3 6NP London, United Kingdom.
| | - Nelly Samchkuashvili
- Department of Radiology, National Heart and Lung Institute, Imperial College, Royal Brompton and Harefield Hospital, London, United Kingdom
| | - Suraj Kadiwar
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Bruce Barton
- Department of Radiology, National Heart and Lung Institute, Imperial College, Royal Brompton and Harefield Hospital, London, United Kingdom
| | - Christoph Nienaber
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Jan Till
- Department of Paediatric Cardiology, Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College, London, United Kingdom
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5
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Khan A, Hasan F, Bandorski D, Lemke B, Linz D, Zarse M, Bimpong-Buta NY, Bogossian H. Transaortic pulmonary vein isolation in the presence of situs inversus and total venous anomaly; technical capabilities for 3D reconstruction and considerations of adequate choice of ablation catheters. IJC HEART & VASCULATURE 2020; 29:100577. [PMID: 32685660 PMCID: PMC7355727 DOI: 10.1016/j.ijcha.2020.100577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 12/04/2022]
Affiliation(s)
- Atisha Khan
- Märkische Kliniken GmbH, Department of Cardiology, Electrophysiology and Angiology, Klinikum Lüdenscheid, Lüdenscheid, Germany
| | - Fuad Hasan
- Märkische Kliniken GmbH, Department of Cardiology, Electrophysiology and Angiology, Klinikum Lüdenscheid, Lüdenscheid, Germany
| | - Dirk Bandorski
- Faculty of Medicine, Semmelweis University Campus Hamburg, Hamburg, Germany
| | - Bernd Lemke
- Märkische Kliniken GmbH, Department of Cardiology, Electrophysiology and Angiology, Klinikum Lüdenscheid, Lüdenscheid, Germany
| | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, the Netherlands.,Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Markus Zarse
- Märkische Kliniken GmbH, Department of Cardiology, Electrophysiology and Angiology, Klinikum Lüdenscheid, Lüdenscheid, Germany.,Department of Cardiology, Witten/Herdecke University, Witten, Germany
| | | | - Harilaos Bogossian
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, the Netherlands.,Department of Cardiology, Witten/Herdecke University, Witten, Germany.,Department of Cardiology and Rhythmology, Ev. Krankenhaus Hagen, Hagen, Germany
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6
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Fitzgerald JL, May AN, Mahmoodi E, Leitch J, Haqqani HM, Jackson N. Cryoballoon ablation from above, through a prosthetic patch atrial septal defect repair. HeartRhythm Case Rep 2020; 6:357-361. [PMID: 32577395 PMCID: PMC7300331 DOI: 10.1016/j.hrcr.2020.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- John L Fitzgerald
- Department of Cardiology, John Hunter Hospital, Newcastle, Australia
| | - Austin N May
- Department of Cardiology, John Hunter Hospital, Newcastle, Australia
| | - Ehsan Mahmoodi
- Department of Cardiology, John Hunter Hospital, Newcastle, Australia
| | - James Leitch
- Department of Cardiology, John Hunter Hospital, Newcastle, Australia
| | - Haris M Haqqani
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
| | - Nicholas Jackson
- Department of Cardiology, John Hunter Hospital, Newcastle, Australia.,School of Medicine, University of Newcastle, Newcastle, Australia
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Chuang CM, Chung FP, Lee PC, Chen SA. Successful Ablation of Ventricular Tachycardia in Repaired Tetralogy of Fallot via Transjugular and Subclavian Approach. ACTA CARDIOLOGICA SINICA 2019; 35:433-436. [PMID: 31371906 DOI: 10.6515/acs.201907_35(4).20190320a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Chieh-Mao Chuang
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei.,Division of Pediatric Cardiology, China Medical University Children's Hospital, China Medical University, Taichung
| | - Fa-Po Chung
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei.,Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University
| | - Pi-Chang Lee
- Division of Pediatric Cardiology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Ann Chen
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei.,Division of Pediatric Cardiology, China Medical University Children's Hospital, China Medical University, Taichung
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8
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Kox T, Laubenthal F, Imnadze G. Successful transseptal puncture and cryoballoon ablation of symptomatic paroxysmal atrial fibrillation via jugular access in a patient with bilateral thrombotic femoral vein occlusion. HeartRhythm Case Rep 2019; 5:347-350. [PMID: 31249783 PMCID: PMC6587028 DOI: 10.1016/j.hrcr.2019.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Thomas Kox
- Department of Cardiology, Evangelic Hospital Oberhausen, Oberhausen, Germany
| | - Florin Laubenthal
- Department of Cardiology, Evangelic Hospital Oberhausen, Oberhausen, Germany
| | - Guram Imnadze
- Department of Arrhythmia Management, Klinikum Osnabrueck, Osnabrueck, Germany
- Address reprint requests and correspondence: Dr Guram Imnadze, Departement of Arrhythmia Management, Klinikum Osnabrück, D – 49076 Osnabrück, Germany.
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The Transjugular Approach: An Alternative Route to Improve Ablation Success in Right Anteriorly and Anterolaterally-Located Supraventricular Tachycardia Substrates in Children. Pediatr Cardiol 2019; 40:477-482. [PMID: 30244304 DOI: 10.1007/s00246-018-1987-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 09/06/2018] [Indexed: 10/28/2022]
Abstract
Catheter ablation via the femoral vein has been widely used in children. However, in certain conditions, an alternative vascular access is required for a successful ablation. Herein we reported that, accessory pathways (APs) and ectopic foci which reside right anterior and anterolateral to tricuspid valve orifice can be safely and effectively ablated with transjugular venous approach. Eleven procedures performed via the transjugular venous approach were reviewed retrospectively from the 355 electrophysiological procedures performed between March 2016 and November 2017. EnSite 3D electro-anatomic mapping and limited flouroscopy was used in all patients. The mean age of patients was 14.4 ± 2.9 years (12-18) and 6/11 (54.5%) were males. Seven of the patients had previous ablation procedures via the femoral vein approach and due to failure or recurrence the procedures had to be repeated. In these patients mean procedure time shortened from 196 ± 80 (105-280) to 111 ± 13 (96-125) min with the transjugular approach. 10/11 patients had APs, and one patient had focal atrial tachycardia. One of the APs was a Mahaim pathway. Ablation localisations were right anterior and right anterolateral in 8/11 and 3/11 patients respectively. The average fluoroscopy time was 3.38 ± 6.5 (0-15) min. All of the RF ablations via transjugular approach were successful (100%, 11/11). The mean follow-up period was 10.6 ± 1.1 (9-12) months. So far no recurrence has been observed. Right anterior and anterolateral regions are the most challenging areas in terms of catheter stabilization even when long sheaths are used during femoral route ablation. Ablation attempts in these regions have partial success, frequent recurrence, and high complication rates. This study revealed that transjugular approach seems as an effective alternative for those cases where transfemoral approach is unsuccessful for the ablation targets located in the right anterior and antero-lateral regions.
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Okajima K, Nakanishi T, Ichibori H, Shirai T, Kadotani M, Shimizu H, Onishi Y, Yamashiro K. Trans-aortic pulmonary vein isolation using magnetic navigation system for paroxysmal atrial fibrillation in a patient with dextrocardia, situs inversus, and inferior vena cava continuity with azygos vein. J Arrhythm 2018; 34:583-585. [PMID: 30327707 PMCID: PMC6174455 DOI: 10.1002/joa3.12096] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 06/26/2018] [Indexed: 11/11/2022] Open
Abstract
A 51-year-old male with dextrocardia and situs inversus underwent catheter ablation for paroxysmal atrial fibrillation. Because the procedure through the trans-septal approach was impossible due to the inferior vena cava continuity with azygos vein, we performed pulmonary vein isolation using magnetic navigation system through the retrograde trans-aortic approach. Superior and inferior left-sided and superior right-sided pulmonary veins could be isolated which was confirmed by the ablation catheter. The patient was free from atrial fibrillation episode at the 12 months follow-up except only one palpitation episode lasting nearly 12 hours at 9 months after the ablation.
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Affiliation(s)
| | | | | | - Takeaki Shirai
- Department of CardiologyKakogawa Central City HospitalKakogawaJapan
| | - Makoto Kadotani
- Department of CardiologyKakogawa Central City HospitalKakogawaJapan
| | - Hiroki Shimizu
- Department of CardiologyKakogawa Central City HospitalKakogawaJapan
| | - Yoshio Onishi
- Department of CardiologyKakogawa Central City HospitalKakogawaJapan
| | - Kohei Yamashiro
- Takatsuki General Hospital Heart Rhythm CenterTakatsukiJapan
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Ekeruo IA, Sharma S, Cohen A, Hematpour K. Hepatic vein access for pulmonary vein isolation in patients without femoral vein access. HeartRhythm Case Rep 2018; 5:395-398. [PMID: 31341786 PMCID: PMC6630107 DOI: 10.1016/j.hrcr.2017.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Ijeoma A. Ekeruo
- Address reprint requests and correspondence: Dr Ijeoma A. Ekeruo, The University of Texas Health Sciences Center at Houston, 6400 Fannin St, Suite 2550, Houston, TX 77030.
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