Atrial Fibrillation Ablation Across an Inferior Vena Cava Filter

Catheter ablation with pulmonary vein isolation is a well-established treatment for symptomatic atrial fibrillation, particularly in patients intolerant to antiarrhythmic therapy. However, the presence of an inferior vena cava (IVC) filter represents a technical challenge for standard transfemoral access. We report the case of a 65-year-old woman with a history of recurrent deep vein thrombosis and a permanent Greenfield IVC filter implanted approximately 15 years prior, who presented with symptomatic paroxysmal atrial fibrillation and intolerance to multiple antiarrhythmic medications. Pulmonary vein isolation was successfully performed via a femoral approach, with guidewires and catheters carefully advanced through the peripheral struts of the filter under fluoroscopic and transesophageal echocardiographic guidance. The procedure was completed without complications. At the sixth-month follow-up, including Holter monitoring, the patient remained in sinus rhythm without recurrence. This case highlights the feasibility of transfemoral pulmonary vein isolation in selected patients with an IVC filter using careful technique and imaging guidance.