Radiofrequency catheter ablation of atrial fibrillation through an implanted inferior vena cava filter

Pulmonary vein isolation (PVI), which creates electrical blocks between pulmonary veins and left atrium, is an established way of catheter ablation for atrial fibrillation (AF). PVI is usually performed via the femoral vein access, using two or three long preshaped sheaths, followed by atrial-septal puncture to approach the left atrium. Here, we treated an AF patient with a permanently implanted inferior vena cava filter (IVC-F) due to deep venous thrombosis (DVT) and pulmonary thromboembolism (PTE). The patient had symptomatic paroxysmal AF for over a decade, which was not controlled under antiarrhythmic drugs including beta-blockers. Therefore, we recommended PVI to treat the AF. However, as the IVC-F was an obstacle to perform conventional PVI, we changed the combination of vascular access sites and devices to perform it safely. Notably, insertions of a single steerable sheath through IVC-F and an intracardiac ultrasound catheter from the right internal jugular vein were useful for the successful completion of the procedure. <Learning objective: Pulmonary vein isolation through an implanted inferior vena cava filter (IVC-F) for an atrial fibrillation patient with IVC-F can be completed by changing the combination of vascular access sites and devices. Notably, insertions of a single "steerable" sheath through IVC-F from the femoral vein and an intracardiac ultrasound catheter from the internal jugular vein are useful for the successful completion of the procedure. Precise evaluation and careful preparation including contrast-enhanced computed tomography are mandatory for this unusual procedure.>.