Abnormal venous return: Still a challenge for electrophysiology procedures? A case report

Area of Science:

• Cardiology
• Electrophysiology
• Medical Imaging

Background:

• Catheter ablation is a standard treatment for cardiac arrhythmias.
• Systemic venous return anomalies can complicate electrophysiological procedures.
• Congenital venous abnormalities pose challenges for cardiac catheterization.

Observation:

• A patient with atrial flutter recurrences presented with interrupted inferior vena cava and a persistent left superior vena cava draining via the coronary sinus.
• Standard femoral venous access was utilized.
• A 55-year-old patient with a history of surgically corrected abnormal pulmonary venous return was treated.

Findings:

• Cavotricuspid isthmus radiofrequency ablation was successfully performed.
• The procedure utilized the persistent left superior vena cava for catheter navigation.
• A three-dimensional electroanatomical mapping system guided the ablation.

Implications:

• Congenital venous anomalies require careful consideration during electrophysiological procedures.
• Three-dimensional electroanatomical mapping systems are crucial for navigating complex venous anatomy.
• Successful ablation of arrhythmias is achievable despite challenging venous abnormalities.