Successful catheter ablation of atrial fibrillation from superior venous
approach.
Abstract
Background: Trans-catheter ablation of drug refractory atrial
fibrillation (AF) is an effective and safe treatment to avoid arrhythmia
recurrences. However, some patients may present anatomic variant making
impossible an inferior venous approach. We report a case of pulmonary
veins isolation (PVI) with cryoballoon technology via right internal
jugular vein (RIJV) access. Methods: After the first trans catheter PVI
attempt was failed due to inferior vena cava (IVC) hypoplasia,
cryoballoon ablation with a 28-mm cryoballoon (AFAPRO - Medtronic
CryoCath LP, Quebec, Canada) via superior venous access was performed. A
quadripolar electrode was inserted in coronary sinus from left basilic
vein. The right internal jugular vein was accessed with Seldinger
technique and left atrial (LA) catheterization was performed via single
trans-septal puncture (TP) under trans-esophageal echocardiographic
(TOE) and fluoroscopy guidance using an SL2 (St. Jude Medical)
trans-septal sheath with a BRK2 (St. Jude Medical) needle. All pulmonary
veins (PVs) were engaged. Cryothermal energy was delivered after
checking the correct occlusion and PVI was successfully obtained for all
PVs. The procedure lasted 210 min, fluoroscopy time was 55 min. During
the 16-month follow-up no sustained atrial arrhythmia recurrence was
detected. Conclusion: PVI with cryoballoon technology in patients with
hypoplasia of IVC can be safely and successfully performed using right
internal jugular access.