Author + information
- Received August 28, 2019
- Revision received October 21, 2019
- Accepted October 24, 2019
- Published online March 16, 2020.
- Jackson J. Liang, DOa,
- Aung Lin, MDb,
- Sanghamitra Mohanty, MD, MSc,
- Daniele Muser, MDb,
- David F. Briceno, MDd,
- J. David Burkhardt, MDc,
- Gregory E. Supple, MDb,
- David J. Callans, MDb,
- Sanjay Dixit, MDb,
- Rodney P. Horton, MDc,
- Luigi Di Biase, MD, PhDd,
- Francis E. Marchlinski, MDb,
- Andrea Natale, MDc and
- Pasquale Santangeli, MD, PhDb,∗ ()
- aDivision of Cardiology, Electrophysiology Section, University of Michigan, Ann Arbor, Michigan
- bDivision of Cardiology, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- cDivision of Cardiology, Texas Cardiac Arrhythmia Institute, Austin, Texas
- dDivision of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York
- ↵∗Address for correspondence:
Dr. Pasquale Santangeli, Division of Cardiology, Electrophysiology Section, Hospital of the University of Pennsylvania, 9 Founders Pavilion–Cardiology, 3400 Spruce Street, Philadelphia, Pennsylvania 19104.
Objectives This study describes the technique and outcomes of atrial fibrillation (AF) ablation via a superior approach in patients with interrupted or absent inferior vena cavas (IVCs).
Background In patients with interrupted or absent IVCs, transseptal access cannot be obtained via standard femoral venous access. In these patients, alternative strategies are necessary to permit catheter ablation in the left atrium (LA). This study reports on the outcomes of AF ablation from a superior venous access with a radiofrequency (RF)-assisted transseptal puncture (TSP) technique.
Methods This study identified patients with interrupted or absent IVCs who underwent AF ablation via a superior approach at 2 ablation centers from 2010 to 2019.
Results Fifteen patients (mean age: 50.8 ± 11.2 years; 10 men; 10 with paroxysmal AF) with interrupted or absent IVCs underwent AF ablation with transseptal access via a superior approach. Successful TSP was performed either with a manually bent RF transseptal needle (early cases: n = 4) or using a RF wire (late cases: n = 11); this approach permitted LA mapping and ablation in all patients. Mean time required to perform single (n = 8) or double (n = 7) TSP was 16.1 ± 4.8 min, and mean total procedure time was 227.9 ± 120.7 min (fluoroscopy time: 57.0 ± 28.5 min). LA mapping and ablation were successfully performed in all patients.
Conclusions In patients with AF undergoing catheter ablation and who had a standard transseptal approach via femoral venous approach is impossible due to anatomic constraints, RF-assisted transseptal access via a superior approach can be an effective alternative strategy to permit LA mapping and ablation.
Dr. Di Biase has been a consultant for Biosense Webster, Stereotaxis, Boston Scientific, and Abbott Medical; and has received honoraria from Medtronic, Bristol-Myers Squibb, and Biotronik. Dr. Natale has been a consultant and speaker for Medtronic, Biotronik, St. Jude, Abbott, Biosense Webster, Bristol-Myers Squibb, and Baylis. Dr. Santangeli has been a consultant for Baylis Medical, Biosense Webster, and Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received August 28, 2019.
- Revision received October 21, 2019.
- Accepted October 24, 2019.
- 2020 American College of Cardiology Foundation
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