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Europace Advance Access originally published online on August 2, 2007
Europace 2007 9(11):1073-1074; doi:10.1093/europace/eum150
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© The European Society of Cardiology 2007. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

ABLATION

Ablation of atrial flutter by the femoral approach in the absence of inferior vena cava

Jens Guenther1, Nassir Marrouche2 and Johannes Ruef1,*

1 Red Cross Hospital Cardiology Center, Pfingstweidstr. 11, D-60316 Frankfurt, Germany; 2 Division of Cardiology, University of Utah, Salt Lake City, UT, USA

This report describes a case of isthmus-dependent atrial flutter ablation by the femoral approach in a 77-year-old patient with a previously unknown absence of the inferior vena cava (IVC). Multi-row detector CT angiography indicated the absence of the perihepatic IVC, whereas the venous blood is drained into the superior vena cava (SVC) via the vena azygos. An ablation catheter could be advanced through the right femoral vein reaching the right heart via vena azygos and SVC. Despite looping of the catheter, ablation and termination of atrial flutter were performed successfully. This is the first report of an inferior-to-superior approach for ablation of atrial flutter in the absence of the perihepatic IVC.

Key Words: Atrial flutter ablation, Venous anomaly, Absence of inferior vena cava, Femoral approach

* Corresponding author. Tel: +49 69 944 340; fax: +49 69 944 341 40.E-mail address: j.ruef{at}kardiocentrum-ffm.de

Manuscript submitted 1 June 2007. Accepted after revision 4 July 2007.


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