Response to flecainide infusion predicts long-term success of inferior vena cava-tricuspid annulus ablation in patients with atrial fibrillation

Abstract Background Transseptal puncture and pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF) are generally performed via the inferior vena cava (IVC). However, in cases where the IVC is inaccessible, a specific strategy may be needed. Case summary An 86-year-old woman with paroxysmal AF and an IVC filter in situ was referred to our hospital for ablation therapy. An IVC filter for pulmonary embolism and deep venous thrombosis had been implanted 15 years prior, therefore we selected a transoesophageal echocardiography (TOE)-guided transseptal puncture using a superior vena cava (SVC) approach. After the single transseptal puncture, we performed fast anatomical mapping, voltage mapping by multipolar mapping catheter, and then PVI by contact force-guided radiofrequency catheter using a steerable sheath. Following the ablation, bidirectional conduction block between the four pulmonary veins and the left atrium was confirmed by both radiofrequency and mapping catheter. No complications occurred and no recurrence of AF was documented in the 12 months after the procedure. Discussion When performing a transseptal puncture during AF ablation, an SVC approach, via access through the right internal jugular vein, enables the sheath to directly approach the left atrium without angulation and improves operability of the ablation catheter. Combining the use of general anaesthesia, TOE, a steerable sheath, and contact force-guided ablation may contribute to achieving minimally invasive PVI with a single transseptal puncture via an SVC approach.

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Role of Inferior Vena Cava Filter Retrieval in Patients on Chronic Anticoagulation Therapy

Current Treatment Options in Cardiovascular Medicine ◽

10.1007/s11936-020-00891-1 ◽

2021 ◽

Vol 23 (2) ◽

Author(s):

Savannah Fletcher ◽

Adam Plotnik ◽

Ravi N. Srinivasa ◽

Jeffrey Forris Beecham Chick ◽

John M. Moriarty

Keyword(s):

Inferior Vena Cava ◽

Inferior Vena Cava Filter ◽

Inferior Vena ◽

Treatment Options ◽

Anticoagulation Therapy ◽

Vena Cava ◽

Vena Cava Filter ◽

Venous Thromboembolic

Abstract Purpose of review Describe the role of inferior vena cava filter (IVCF) retrieval in patients on chronic anticoagulation given the overlap of these treatment options in the management of patients with venous thromboembolic disease. Recent findings Despite the increase in IVCF retrievals since the Food and Drug Administration safety communications in 2010 and 2014, retrieval rates remain low. Previous studies have shown that longer filter dwell times are associated with greater risk for filter complications and more difficulty with filter retrievals. Recent findings suggest that complications are more frequent in the first 30 days after placement. Summary The decision to retrieve an optional IVCF is individualized and requires diligent follow-up with consistent re-evaluation of the need for the indwelling IVCF, particularly in those on long-term anticoagulation therapy.

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Retrieval of Bard Simon Nitinol inferior vena cava filters: Approaches, technical successes, complications, and clinical outcomes

Phlebology The Journal of Venous Disease ◽

10.1177/0268355520925986 ◽

2021 ◽

pp. 026835552092598

Author(s):

Jacob J Bundy ◽

Jeffrey Forris Beecham Chick ◽

Ravi N Srinivasa ◽

Kyle J Cooper ◽

Joseph J Gemmete ◽

...

Keyword(s):

Inferior Vena Cava ◽

Inferior Vena ◽

Vena Cava ◽

Inferior Vena Cava Filters ◽

Vena Cava Filters ◽

Venous Thromboembolic Events ◽

Venous Thromboembolic ◽

Vena Cava Thrombosis ◽

Inferior Vena Cava Thrombosis

Objective The Simon Nitinol filter is a bi-level filtration device designed for permanent implantation that is no longer commercially available, but may result in similar complications to current commercially available long term indwelling temporary or permanent filters. Complications related to indwelling inferior vena cava filters include inferior vena cava thrombosis, inferior vena cava penetration, filter migration, and filter fracture. There is a paucity of reports describing the technical aspects related to retrieval of Simon Nitinol filters. Materials and methods This study consisted of five patients with Simon Nitinol filters and describes the indication for retrieval, the retrieval techniques used to remove the filters, technical success, complications, and clinical course. Results The indications for retrieval included: abdominal pain ( n = 2; 40%), iliocaval thrombosis ( n = 1; 20%), identification of an intracardiac filter fragment ( n = 1; 20%), and recurrent venous thromboembolic events ( n = 1; 20%). Retrieval techniques included: biopsy forceps ( n = 3; 60%), excimer laser extraction sheaths ( n = 3; 60%), hangman modified loop snares ( n = 3; 60%), rigid endobronchial forceps ( n = 2; 40%), and balloon deflection ( n = 2; 40%). All filters were successfully retrieved. One patient developed a post-procedural intramuscular hematoma near the site of right internal jugular sheath placement. Conclusions Simon Nitinol filters may be retrieved safely and effectively using advanced inferior vena cava filter retrieval techniques.

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