Modified Mini-Maze for Atrial Fibrillation with Interruption of Inferior Vena Cava

A 57-year-old female with paroxysmal atrial fibrillation and an interrupted inferior vena cava (IVC) was referred to our hospital for radiofrequency ablation. Transseptal puncture and left atrium ablation failed through a standard IVC approach via the femoral vein due to intrahepatic interruption of IVC. We performed a modified mini-maze procedure in this patient through the left thoracic cavity under video-assisted thoracoscopic surgery (VATS). We can successfully complete pulmonary vein (PV) isolation, left atrium box isolation, cardiac ganglia ablation, Marshall ligament ablation, and coronary sinus epicardium ablation using this technique.

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Modified mini-maze via left thoracic cavity under VATS for paroxysmal atrial fibrillation in a patient with complete interruption of the inferior vena cava

10.22541/au.161080830.05435158/v1 ◽

2021 ◽

Author(s):

Fan He ◽

Bijun Xu ◽

Shiqiang Wang ◽

Huai-Dong Chen ◽

Weimin Zhang

Keyword(s):

Atrial Fibrillation ◽

Radiofrequency Ablation ◽

Inferior Vena Cava ◽

Left Atrium ◽

Inferior Vena ◽

Vena Cava ◽

Maze Procedure ◽

Thoracic Cavity ◽

Left Chest ◽

Bipolar Radiofrequency

Objectives: We sought to determine the technical feasibility of surgical bipolar radiofrequency ablation (endoscopic maze procedure) through the left chest cavity in patients with an interrupted inferior vena cava (IVC). Methods and Results: A 57-year-old female with paroxysmal atrial fibrillation (AF) and an interrupted IVC was referred to our hospital for radiofrequency ablation. Transseptal puncture and left atrium (LA) ablation failed through a standard IVC approach via the femoral vein due to intrahepatic interruption of IVC. We performed a modified surgical bipolar radiofrequency ablation (RF) on the beating heart through 3 ports in the left chest wall. Pulmonary vein isolation and ablation of the left atrium were achieved by bipolar radiofrequency ablation. Ganglionic plexus ablation was completed using the ablation pen. The left atrial appendage was excluded. No complications occurred during or after the procedure. The patient was discharged with sinus rhythm 3 days later after the procedure. She was taking amiodarone (100mg bid) within 6 months after the procedure, and had no recurrence of AF. Conclusions: We successfully performed a modified mini-maze procedure in a patient with paroxysmal AF and IVC interruption through the left thoracic cavity under video-assisted thoracoscopic surgery (VATS). We can successfully complete pulmonary vein (PV) isolation, left atrium box isolation, cardiac ganglia ablation, Marshall ligament ablation, and coronary sinus epicardium ablation using this technique.

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A case report of pulmonary vein isolation with radiofrequency catheter using superior vena cava approach in patient with paroxysmal atrial fibrillation and inferior vena cava filter

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa562 ◽

2021 ◽

Vol 5 (2) ◽

Author(s):

Masatoshi Narikawa ◽

Masayoshi Kiyokuni ◽

Junya Hosoda ◽

Toshiyuki Ishikawa

Keyword(s):

Atrial Fibrillation ◽

Inferior Vena Cava ◽

Left Atrium ◽

Inferior Vena ◽

Superior Vena ◽

Vena Cava ◽

Ivc Filter ◽

Transseptal Puncture ◽

Mapping Catheter ◽

Steerable Sheath

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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Radiofrequency ablation for paroxysmal atrial fibrillation in a patient with dextrocardia and interruption of the inferior vena cava: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab191 ◽

2021 ◽

Vol 5 (5) ◽

Author(s):

Xiaofeng Hu ◽

Shaohui Wu ◽

Mu Qin ◽

Weifeng Jiang ◽

Xu Liu

Keyword(s):

Atrial Fibrillation ◽

Case Report ◽

Inferior Vena Cava ◽

High Power ◽

Inferior Vena ◽

Femoral Vein ◽

Vena Cava ◽

Transseptal Puncture ◽

Rf Ablation ◽

Anatomical Variant

Abstract Background Dextrocardia with interruption of the inferior vena cava (I-IVC) is a very rare anatomical variant. Catheter ablation of atrial fibrillation (AF) in patients with this anatomical variant is challenging for electrophysiologists. This case report presents a safe, effective, and radiation-free approach for high-power ablation of AF via a superior transseptal approach in patients with dextrocardia and I-IVC. Case summary A 57-year-old man with paroxysmal AF with dextrocardia and I-IVC with azygos continuation was referred to our hospital for radiofrequency (RF) ablation. It was evident that transseptal puncture and pulmonary vein isolation (PVI) would be impossible using an IVC approach via the femoral vein. Therefore, we decided to perform left atrium (LA) ablation via the superior vena cava approach. A phased array intracardiac echocardiography (ICE) catheter was inserted in the right femoral vein. Three-dimensional (3D) anatomical reconstruction of LA, right atrium (RA), and coronary sinus (CS) ostium were performed using ICE with azygos vein and RA imaging. Navigation-enabled electrodes were inserted into annotated CS on cardiac 3D ICE image. The left internal jugular vein was accessed using an SL1 transseptal sheath and Brockenbrough needle. Transseptal puncture was performed under ICE with an RF-assisted approach. We accomplished ablation index guided high-power pulmonary vein isolation using a bi-directional guiding sheath with visualization capabilities and a surround flow contact force-sensing catheter. No complications occurred during or after the procedure. Discussion With the application of multitude of newer technologies, we can accomplish safe, effective, and fluoroscopy-free RF ablation of AF using the superior approach in patients with complex anomaly.

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P1732 Congenital absence of the inferior vena cava: challenge for catheter ablation of arrhythmias via the femoral vein approach

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.1093 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

R S Prisecaru ◽

C Leatu ◽

O Purcar ◽

C Pitis ◽

V Costache

Keyword(s):

Catheter Ablation ◽

Inferior Vena Cava ◽

Left Atrium ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Inferior Vena ◽

Femoral Vein ◽

Vena Cava ◽

Congenital Absence ◽

Congenital Cardiac Anomalies

Abstract Introduction Congenital anomalies of the inferior vena cava (IVC) are a well described entity. These anomalies include complete absence, partial absence or duplication of the IVC. They are seen more frequently in those with other congenital cardiac anomalies (0.6%–2%). This congenital condition can be discovered incidentally, or due to symptoms of associated congenital heart disease, asplenia, polysplenia, congenital kidney anomalies or deep venous thrombosis. Case report We report the case of a 48 years old man scheduled for pulmonary vein isolation due to persistent atrial fibrillation resistant to antiarhythmic drugs, symptomatic for palpitations and dyspnea on exertion. Transthoracic ecgocardiography showed mild left atrium enlargement, normal systolic LV function and no significant valve disease. The transoesophageal echocardiography revealed dilation of the left atrium and absence of thrombus in the left atrium or left appendage. Multi-slice spiral thoracic computed tomography (MSCT) was also performed before the procedure and revealed absence of the inferior vena cava and significant dilation of the azygos and hemiazygos veins with subsequent drainage into the superior vena cava. Abdominal CT showed also partial situs inversus. Pulmonary vein isolation (PVI) through femoral vein approach was cancelled and the patient was scheduled for remote magnetic navigation PVI through arterial approach. Conclusions Whether the absence of the IVC is an embryonic anomaly or the result of perinatal thrombosis with regression and subsequent congenital absence of the IVC, absence of the IVC creates difficulties for catheter ablation of arrhythmias via the femoral vein approach.

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Paracardioscopy Provides Endoscopic Visualization of the Heart

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e3181b03b78 ◽

2009 ◽

Vol 4 (4) ◽

pp. 233-235 ◽

Cited By ~ 3

Author(s):

Andy C. Kiser

Keyword(s):

Atrial Fibrillation ◽

Inferior Vena Cava ◽

Left Atrium ◽

Inferior Vena ◽

Pulmonary Veins ◽

Vena Cava ◽

Right Atrial ◽

Cardiac Procedures ◽

Left And Right ◽

Right Atrial Appendage

Paracardioscopy provides totally endoscopic access to the heart via a transabdominal, transdiaphragmatic approach. Structures such as the pulmonary veins, inferior vena cava, left and right atrial appendage, and posterior left atrium can be visualized. Epicardial cardiac procedures, such as ablation procedures for atrial fibrillation, can be successfully performed using this development. This report describes paracardioscopy.

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