Transseptal puncture from the jugular vein and balloon cryoablation for atrial fibrillation in a patient with azygos continuation of an interrupted inferior vena cava

摘要: Aims Inferior vena cava (IVC) interruption is a rare anatomic variant where the azygos vein (AV) drains blood from IVC to upper part of right atrium via superior cava. Here, we report balloon cryoablation pulmonary veins (PVs) access in patient with atrial fibrillation. Methods and results After first failed ablation attempt due interruption, 28-mm Arctic Front Advance cryoballoon (Medtronic CryoCath LP, Quebec, Canada) was performed; it requires only single transseptal puncture (TP), had optimal PV anatomy. Deflectable electrodes were inserted into ventricle coronary sinus femoral vein. The internal jugular accessed using an SL0 sheath BRK needle. TP performed under transoesophageal echocardiographic guidance Safe Sept wire because septum stiff. All PVs engaged: left catheter before insertion inferior following ‘push-up’ technique leak above veins. Cryothermal energy delivered after checking for occlusion. procedure lasted 210 min, fluoroscopy time 78 air-kerma dose 194 mGy. During 6-month follow-up, no episodes fibrillation detected on several Holter recordings. Conclusions Successful isolation patients AV continuation interrupted can be safely cryoablation, modifications standard equipment.