Case Report
A 58-year-old female patient was presented with recurrent palpitation
for one month. Holter electrocardiography monitoring showed paroxysmal
AF. She did not respond to oral anti-arrhythmia medicine and was
admitted for catheter ablation. Echocardiography revealed a 40mm left
atrium in anteroposterior diameter and 62% left ventricular ejection
fraction (LVEF). During the procedure, cardiologist could not put the
catheter into the right atrium. Angiography showed interruption of the
IVC. Further computed tomographic venography
(CTV)
showed
double
IVC with intrahepatic interruption,
azygos
and hemiazygos vein continuation, and intrahepatic venous shunt. The
hepatic vein was shown to connect the right atrium (Figure 1).
We decided to perform Modified mini-maze via left thoracic cavity under
VATS on this
patient.
The procedure was performed on the beating heart through 3 ports in the
left chest wall (Figure 2). The pulmonary vein isolation and ablation of
the left atrium were achieved by bipolar radiofrequency ablation with
AtriCure Isolator Synergy ablation clamp(Figure 3). Ganglionic plexus
ablation was completed using the AtriCure Isolator Synergy ablation pen.
The left atrial appendage was excluded. The operation was very
successful and no complications occurred during or after the procedure.
The patient was discharged with sinus rhythm 3 days later after the
procedure. She was taking amiodarone (100mg bid) within 6 months after
the procedure, and had no recurrence of AF.