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.