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

Hong Euy Lim, Hui Nam Pak, Hung Fat Tse, Chu Pak Lau, Chun Hwang, Young Hoon Kim

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Background: Percutaneous transcatheter ablation of atrial fibrillation (AF) in patients with interruption of inferior vena cava (IVC) has not been reported in the literature. Objective: 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. Methods: 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. Results: 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. Conclusion: AF ablation via the superior approach is a safe and feasible alternative technique when a femoral venous approach is not available.

Original languageEnglish
Pages (from-to)174-179
Number of pages6
JournalHeart Rhythm
Volume6
Issue number2
DOIs
Publication statusPublished - 2009 Feb 1

Fingerprint

Catheter Ablation
Inferior Vena Cava
Atrial Fibrillation
Pulmonary Veins
Jugular Veins
Punctures
Atrial Flutter
Anti-Arrhythmia Agents
Thigh
Needles
Cardiac Arrhythmias
Catheters
Safety

Keywords

  • Atrial fibrillation
  • Catheter ablation
  • Vena cava abnormalities

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Catheter ablation of atrial fibrillation via superior approach in patients with interruption of the inferior vena cava. / Lim, Hong Euy; Pak, Hui Nam; Tse, Hung Fat; Lau, Chu Pak; Hwang, Chun; Kim, Young Hoon.

In: Heart Rhythm, Vol. 6, No. 2, 01.02.2009, p. 174-179.

Research output: Contribution to journalArticle

Lim, Hong Euy ; Pak, Hui Nam ; Tse, Hung Fat ; Lau, Chu Pak ; Hwang, Chun ; Kim, Young Hoon. / Catheter ablation of atrial fibrillation via superior approach in patients with interruption of the inferior vena cava. In: Heart Rhythm. 2009 ; Vol. 6, No. 2. pp. 174-179.
@article{3dee898fdbd6420794acf87d9db6c7ed,
title = "Catheter ablation of atrial fibrillation via superior approach in patients with interruption of the inferior vena cava",
abstract = "Background: Percutaneous transcatheter ablation of atrial fibrillation (AF) in patients with interruption of inferior vena cava (IVC) has not been reported in the literature. Objective: 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. Methods: 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. Results: 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. Conclusion: AF ablation via the superior approach is a safe and feasible alternative technique when a femoral venous approach is not available.",
keywords = "Atrial fibrillation, Catheter ablation, Vena cava abnormalities",
author = "Lim, {Hong Euy} and Pak, {Hui Nam} and Tse, {Hung Fat} and Lau, {Chu Pak} and Chun Hwang and Kim, {Young Hoon}",
year = "2009",
month = "2",
day = "1",
doi = "10.1016/j.hrthm.2008.10.026",
language = "English",
volume = "6",
pages = "174--179",
journal = "Heart Rhythm",
issn = "1547-5271",
publisher = "Elsevier",
number = "2",

}

TY - JOUR

T1 - Catheter ablation of atrial fibrillation via superior approach in patients with interruption of the inferior vena cava

AU - Lim, Hong Euy

AU - Pak, Hui Nam

AU - Tse, Hung Fat

AU - Lau, Chu Pak

AU - Hwang, Chun

AU - Kim, Young Hoon

PY - 2009/2/1

Y1 - 2009/2/1

N2 - Background: Percutaneous transcatheter ablation of atrial fibrillation (AF) in patients with interruption of inferior vena cava (IVC) has not been reported in the literature. Objective: 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. Methods: 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. Results: 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. Conclusion: AF ablation via the superior approach is a safe and feasible alternative technique when a femoral venous approach is not available.

AB - Background: Percutaneous transcatheter ablation of atrial fibrillation (AF) in patients with interruption of inferior vena cava (IVC) has not been reported in the literature. Objective: 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. Methods: 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. Results: 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. Conclusion: AF ablation via the superior approach is a safe and feasible alternative technique when a femoral venous approach is not available.

KW - Atrial fibrillation

KW - Catheter ablation

KW - Vena cava abnormalities

UR - http://www.scopus.com/inward/record.url?scp=58849126610&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=58849126610&partnerID=8YFLogxK

U2 - 10.1016/j.hrthm.2008.10.026

DO - 10.1016/j.hrthm.2008.10.026

M3 - Article

C2 - 19187906

AN - SCOPUS:58849126610

VL - 6

SP - 174

EP - 179

JO - Heart Rhythm

JF - Heart Rhythm

SN - 1547-5271

IS - 2

ER -