title: Catheter ablation of atrial fibrillation via superior approach in patients with interruption of the inferior vena cava.
abstract: BACKGROUND
  Percutaneous transcatheter ablation of atrial fibrillation (AF) in patients with interruption of inferior vena cava (IVC) has not been reported in the literature.
  
  
  OBJECTIVE
  The purpose of this article was to demonstrate the safety and feasibility of the superior approach via the right internal jugular vein in performing catheter ablation of AF.
  
  
  METHODS
  We performed AF ablation in 3 patients (mean age: 51.7 +/- 18.5 years, 2 paroxysmal AF and 1 persistent AF) with complete interruption of IVC. Transseptal puncture was performed via the right internal jugular vein with a long sheath and manually curved Brockenbrough needle to facilitate the tip downward to the FO. Three-dimensional (3D) mapping was performed in 2 patients. Electrical isolation of each pulmonary vein (PV) was confirmed by a circular mapping catheter. Bidirectional block at the RA isthmus was achieved in 1 patient with clinically documented typical atrial flutter.
  
  
  RESULTS
  In all patients, AF ablation after transseptal puncture via the superior approach was successfully performed without complications. Selective PV isolation of arrhythmogenic PV was done in 1 patient, and circumferential bilateral antral ablations were done in 2 patients. In 1 patient with persistent AF, linear ablations of left atrial roof and perimitral and RA isthmus were done after electrical isolation of all PVs. At a mean follow-up of 18.7 +/- 15.5 months, arrhythmias were free without any antiarrhythmic drugs in all patients.
  
  
  CONCLUSIONS
  AF ablation via the superior approach is a safe and feasible alternative technique when a femoral venous approach is not available.
authors.affiliation: Division of Cardiology, Korea University Cardiovascular Center, Korea University College of Medicine, Seoul, Korea.
authors.forename: Hong Euy
authors.initials: HE
authors.lastname: Lim
authors.forename: Hui-Nam
authors.initials: HN
authors.lastname: Pak
authors.forename: Hung-Fat
authors.initials: HF
authors.lastname: Tse
authors.forename: Chu-Pak
authors.initials: CP
authors.lastname: Lau
authors.forename: Chun
authors.initials: C
authors.lastname: Hwang
authors.forename: Young-Hoon
authors.initials: YH
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000295:instrumentation / Q000379:methods*; D003287:Contrast Media / Q000008:administration & dosage; D004562:Electrocardiography; D004867:Equipment Design; D005240:Feasibility Studies; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D011677:Punctures; D012449:Safety; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000002:abnormalities*
chemical_list: D003287:Contrast Media