HotBalloon ablation of atrial fibrillation in patients with dextrocardia and situs inversus by “mirror image” approach

Abstract

A 51‐year‐old man with dextrocardia and complete situs inversus who presented with palpitation as a result of drug refractory paroxysmal atrial fibrillation (AF) was referred to our hospital for catheter ablation. Pulmonary vein isolation (PVI) was performed using the HotBalloon technique. We were able to accomplish AF ablation safely and easily using 180 degree‐inversed mirror images of X‐ray fluoroscopy. We have reported successful PVI for AF with dextrocardia using HotBalloon and mirror image of X‐ray fluoroscopy without any complication for the first time.

Pulmonary Vein Isolation and Pacemaker Implantation in a Patient with Dextrocardia Situs Inversus

“…AF ablation in patients with DSI has already been reported with the use of diverse modalities including conventional RFCA, 3) Cryoballoon, 4) and HotBalloon. 5) However, unlike the previous cases, the present case had PRSVC and IVC occlusion. Therefore, a standard transseptal approach via the femoral veins was impossible, but we had no choice but to perform it via the left jugular vein approach, which was technically harder than before.…”

“…Currently, pulmonary vein isolation (PVI) is a widely acceptable therapeutic strategy for AF and is much effective compared to drug therapies. 2) Previous studies demonstrated that some cases with DSI accompanied with AF had undergone PVI using radiofrequency catheter ablation (RFCA) or balloon ablation, [3][4][5] although that is not always easy for a patient with DSI. Contrarily, a cardiac implantable electrical device for patients with DSI has been reported, 6,7) in which the transvenous lead implantation was also challenging.…”

Robotic magnetic navigation-guided pulmonary vein isolation in an atrial fibrillation patient with dextrocardia situs inversus: techniques and potential advantages

“…There are few case reports demonstrated that patients with DSI accompanied with AF have undergone successful PVI using manual cryoballoon [ 4 ], hotballoon [ 5 ], and manual-guided RF ablation [ 6 , 7 ]. However, catheter and long sheath manipulations in manual-guided ablation are complex in cases of heart inversion, making it more difficult to achieve good catheter-to-tissue contact during PVI, especially in the left atrial ridge area [ 8 ].…”

Atrial fibrillation and atrial flutter ablation using mirror image in a patient with dextrocardia and situs inversus

“…However, it should be kept in mind that catheter manipulations should be performed in the opposite direction. Miyauchi et al ( 2 ) have described a case of hot balloon ablation in a patient with paroxysmal AF with complete situs inversus with the help of a mirror image; they performed the procedure under the guidance of ICE. However, ICE may not always be available.…”