Case 4
A 63 year old man with persistent atrial fibrillation (AF) and history of transient ischemic attack (TIA) was admitted for pulmonary vein isolation (PVI). Venography showed interruption of IVC with azygos continuation. The CS catheter placement was through the azygos vein. The right internal jugular vein was cannulated and transseptal puncture was done using SL3 sheath and transseptal puncture needle (150 degree) (Figure 4A and 4B). After transseptal puncture, synchronized cardioversion (100J) was done to restore sinus rhythm. Four PVI was performed successfully via right internal jugular vein approach and post-ablation induction test was negative (Figure 4C).