Ablation in Dextrocardia With Interrupted Inferior Vena Cava and Azygos Continuation to Coronary Sinus
Xiaobo Liao1, Longjiang Hu2, Lan Ren3
1Department of Cardiology, Beijing Anzhen Hospital, National Clinical Research Center for Cardiovascular Diseases, Capital Medical University, Beijing, China; Cardiology Department, Chongqing University Fuling Hospital, Chongqing University, Chongqing, China.
Background:
Atrial fibrillation ablation in dextrocardia with interrupted inferior vena cava presents formidable technical challenges, particularly when anomalous systemic venous return distorts interatrial septal relationships.
Case Summary:
A 58-year-old man with drug-refractory paroxysmal atrial fibrillation, situs inversus totalis with dextrocardia, and inferior vena cava interruption with azygos continuation to the coronary sinus underwent catheter ablation. Lacking an inferior route, a superior approach through the left internal jugular vein was selected. Under intracardiac echocardiography (ICE) guidance, transseptal access was obtained using a dedicated wire-based system. Pulmonary vein isolation and roofline ablation were safely completed using radiofrequency energy.
Discussion:
Azygos continuation to the coronary sinus drastically distorts interatrial geometry. ICE-guided, wire-based transseptal access via a superior route is a safe, practical alternative when conventional inferior access is unavailable and needle-based puncture poses high risks.
Take-Home Messages:
In situs inversus, the left internal jugular vein offers an optimal trajectory for transseptal puncture via a superior approach. Using a dedicated transseptal guidewire instead of a rigid needle, strictly guided by ICE, reduces the risk of mechanical complications during atypical transseptal punctures in complex congenital heart disease.
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