title: Transseptal puncture and catheter ablation via the superior vena cava approach for persistent atrial fibrillation in a patient with polysplenia syndrome and interruption of the inferior vena cava: contact force-guided pulmonary vein isolation.
abstract: OBJECTIVE
  We sought to establish the technical feasibility of transseptal puncture and left atrial (LA) ablation through the right internal jugular vein via the superior vena cava (SVC) approach in patients with an interrupted inferior vena cava (IVC).
  
  
  RESULTS
  A 34-year-old man with persistent atrial fibrillation (AF) and polysplenia syndrome (hypoplasia of the left kidney, aplasia of the pancreas tail, bilaterally bilobed lungs, and an interrupted IVC) was referred to our hospital for radiofrequency ablation. Because transseptal puncture and LA ablation would be impossible by a standard IVC approach via the femoral vein, we performed transseptal puncture and LA ablation through the right internal jugular vein via the SVC approach using a manually curved Brockenbrough needle and intracardiac echocardiographic guidance. We accomplished pulmonary vein (PV) isolation using a deflectable guiding sheath and a contact force-sensing ablation catheter to monitor the contact force and the force-time integral of the tip of the ablation catheter. No complications occurred during or after the procedure. The patient was discharged home without recurrence of AF 3 days after the procedure. He had no recurrence of AF and was taking no medication 5 months after ablation.
  
  
  CONCLUSIONS
  We successfully performed transseptal puncture in a patient with persistent AF, polysplenia syndrome, and complete interruption of the IVC using the superior route through the internal jugular vein. We also accomplished PV isolation using a deflectable guiding sheath and real-time monitoring of the contact force of the ablation catheter.
authors.affiliation: Department of Cardiology, Fukui Kosei Hospital, Shimorokujyo-cho 201, Fukui 918-8537, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kato
authors.affiliation: Department of Cardiology, Fukui Kosei Hospital, Shimorokujyo-cho 201, Fukui 918-8537, Japan.
authors.forename: Shoichi
authors.initials: S
authors.lastname: Kubota
authors.affiliation: Department of Cardiology, Fukui Kosei Hospital, Shimorokujyo-cho 201, Fukui 918-8537, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Goto
authors.affiliation: Cardiovascular Center, Sakurabashi-Watanabe Hospital, Osaka 530-0001, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Inoue
authors.affiliation: HIMEDIC Clinic WEST, Osaka 542-0081, Japan.
authors.forename: Naohiko
authors.initials: N
authors.lastname: Oku
authors.affiliation: Department of Internal Medicine, Fukui Kosei Hospital, Fukui 918-8537, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Haba
authors.affiliation: Department of Internal Medicine, Fukui Kosei Hospital, Fukui 918-8537, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Yamamoto
mesh_terms: D000015:Abnormalities, Multiple; D000328:Adult; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods*; D017115:Catheter Ablation; D002405:Catheterization, Central Venous / Q000379:methods*; D004452:Echocardiography; D006346:Heart Septum / Q000000981:diagnostic imaging; D059446:Heterotaxy Syndrome / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011677:Punctures; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000002:abnormalities* / Q000000981:diagnostic imaging; D014683:Vena Cava, Superior / Q000000981:diagnostic imaging
keywords: Atrial fibrillation; Catheter ablation; Contact force; Interruption of the inferior vena cava; Polysplenia syndrome; Transseptal puncture