1. Introduction
Azygos and hemiazygos continuation of the inferior vena cava (IVC)
occurs in up
to 0.6% of the population. [1] Interruption of the IVC is uncommon
but one might come across this condition during electrophysiology
procedures. Anatomical anomalies such as bifurcating or tortuous veins,
or IVC occlusion by prosthetic material or thrombus could also make
femoral access impossible in catheter ablation.
Previous case reports had demonstrated that it is feasible for catheter
ablation via superior approach, either via jugular or subclavian vein,
in atrioventricular nodal reentry tachycardia (AVNRT) [2] [3]
[4] [5], accessory pathway [6] [7], typical atrial
flutter [8], atrial fibrillation [9] [10], and right
ventricular arrhythmia. [11] [12][13]
A superior approach with an advanced three-dimensional (3-D) mapping
system might reduce the number of vascular access in these cases. In
this case series, we presented four tachyarrhythmia cases with
interruption of the IVC or bilateral lower leg deep vein thrombosis. All
the tachyarrhythmias were successfully eliminated by catheter ablation
using superior approach under the guidance of 3-D mapping system.
The present study was approved by the Institutional Review Board at
Taipei Veterans General Hospital, Taipei, Taiwan.