Successful transseptal puncture and cryoballoon ablation of symptomatic paroxysmal atrial fibrillation via jugular access in a patient with bilateral thrombotic femoral vein occlusion

Cryoballoon ablation from above, through a prosthetic patch atrial septal defect repair

“…A small number of other cases in the literature with a similar superior approach for AF ablation have shown this approach to be feasible, when necessary. [1][2][3][4][5]8 The IVC is formed from anastomosis of 3 pairs of veins during the fifth to seventh weeks of gestation, with 5 segments contributing to its final structure. 6 Interruption or stenosis of this structure has been found in ,1% of cases in imaging series, and is asymptomatic in cases where the azygos system is well developed, which occurs in roughly half of these.…”

“…Pulmonary vein isolation to treat atrial fibrillation (AF) is challenging where the usual femoral route is not possible. [1][2][3][4][5] Interruption of the inferior vena cava (IVC) is a rare anatomic variant, with or without azygos venous system drainage of the lower body into the superior vena cava (SVC). 6,7 This anatomy necessitates an alternative approach for transseptal puncture to allow catheter access to the left atrium, and has been described for both radiofrequency and cryoballoon ablation strategies for AF ablation.…”