Fluoroless PVC Ablation Via the Internal Jugular Vein in Interrupted Inferior Vena Cava

Interrupted inferior vena cava is a rare congenital anomaly that complicates catheter ablation.

A 70-year-old woman with premature ventricular complexes was referred for ablation. Intracardiac echocardiography identified an interrupted inferior vena cava with azygos continuation, an anomaly retrospectively identifiable on prior computed tomography. Catheter manipulation was difficult, and the femoral route was abandoned. Switching to the right internal jugular vein approach allowed easier manipulation of mapping and ablation catheters. Using intracardiac echocardiography and 3-dimensional electroanatomical mapping, the premature ventricular complex focus was localized to the inferolateral right ventricle apex and successfully ablated without fluoroscopy.