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.