Figure 1 - available via license: Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International
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A: The 12-lead electrocardiogram (ECG) represents a regular usual complex tachycardia obtained in the emergency department. B: The 12-lead ECG in sinus rhythm.
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Purpose
Catheter ablation for supraventricular tachycardia (SVT) in adults with congenital heart disease (ACHD) is an important therapeutic option. Cavo-tricuspid isthmus (CTI)-dependent intraatrial re-entrant tachycardia (IART) is common. However, induction of sustained tachycardia at the time of ablation is not always possible. We hypothesised th...
Citations
... Since there is limited evidence about using the transhepatic approach for invasive electrophysiology procedures in the adult population, most of what is known derives from studies done in pediatric populations, where it has been reported as feasible, with a low (,5%) complication rate. 10 According to Soto and colleagues, 11 among the reported complications associated with the transhepatic approach are hemothorax, transaminitis, liver hematoma, thrombosis of We did not observe complications from the transhepatic approach in any of our cases. We used 1 Amplatzer Vascular Plug (Abbott, Chicago, IL) and Gelfoam (Pfizer, New York, NY) to assist with the hemostasis of both of our patients. ...
... The next day, an abdominal ultrasound ruled out hepatic bleeding. Our team previously showed the feasibility of the middle hepatic vein access for an atrial tachyarrhythmia ablation [3]. In this case, we disclose that the RHV access is feasible as well for AVNRT ablation in a patient with infrarenal vena ...
... The next day, an abdominal ultrasound ruled out hepatic bleeding. Our team previously showed the feasibility of the middle hepatic vein access for an atrial tachyarrhythmia ablation [3]. In this case, we disclose that the RHV access is feasible as well for AVNRT ablation in a patient with infrarenal vena Publisher's note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. ...
... There have been previous reports of electrophysiological procedures conducted through nontraditional vascular access. [3][4][5][6][7][8] Here we describe, to our knowledge, the first case of a transhepatic access and successful deployment of a Watchman device without leaving an indwelling catheter at the access site. ...
... Ideally this procedure is performed from an inferior approach owing to catheter design and stability. 4,5 The challenge with alternative sites for access and LAAC include vessel caliber, transseptal puncture using available technologies, and maneuverability of the WAS from the alternative access. Furthermore, more invasive routes requiring surgical cutdown and subsequent repair would be more involved than the minimally invasive nature of LAAC. ...
... Furthermore, often LAAC will be completed while the patient is on OAC, further complicating surgical approaches. The hepatic vein presents a target that is easily accessible and has been reported previously to be technically feasible for ablation of AF. [5][6][7][8] While transhepatic central venous access has been well described for multiple pediatric applications, adult use for cardiac cases is sparsely described in the literature, most commonly as alternative access for ablation procedures. [3][4][5][6][7][8] Reasons for inability to access include complete iliofemoral occlusion, congenitally absent IVC, and surgical ligation of the IVC. 3 Our case presents an alternative multidisciplinary team-based approach to LAAC via hepatic venous access with successful closure of the access site using an Amplatzer plug and Gelfoam. ...
Background
Transfemoral venous access (TFV) is the cornerstone of minimally invasive cardiac procedures. Although the presence of inferior vena cava filters (IVCF) was considered a relative contraindication to TFV procedures, small experiences have suggested safety. We conducted a systematic review of the available literature on cardiac procedural success of TFV with IVCF in‐situ.
Methods
Two independent reviewers searched PubMed, EMBASE, SCOPUS and Google Scholar from inception to October 2020 for studies that reported outcomes in patients with IVCFs undergoing TFV for invasive cardiac procedures. We investigated a primary outcome of acute procedural success and reviewed the pooled data for patient demographics, procedural complications, types of IVCF, IVCF dwell time and procedural specifics.
Results
Of the 120 studies initially screened, 8 studies were used in the final analysis with a total of 100 patients who underwent 110 procedures. The most common IVCF was the Greenfield Filter (36%), 60% of patients were males and the mean age was 67.8 years. The overall pooled incidence of acute procedural success was 95.45% (95% confidence interval 89.54. ‐ 98.1) with no heterogeneity (I2 = 0%, p = 1) and there were no reported filter related complications.
Conclusion
This systematic review is the largest study of its kind to demonstrate the safety and feasibility of TFV access in a variety of cardiac procedures in the presence of IVCF.
This article is protected by copyright. All rights reserved.
Background:
Interrupted inferior vena cava (IVC) is a rare venous anomaly that complicates treatment of patients who require electrophysiology (EP) procedures.
Methods:
We describe five consecutive cases of patients with interrupted IVC who presented to the EP laboratory requiring interventional procedures including catheter ablation for atrial fibrillation and supraventricular tachycardia and left atrial appendage closure. All cases were successfully completed utilizing a variety of approaches to vascular access including transseptal puncture via transhepatic and internal jugular approaches.
Conclusion:
Procedures in the EP lab can be performed successfully in patients with interrupted IVC. This article is protected by copyright. All rights reserved.
We describe placement of a covered stent in an occluded left superior vena cava to right atrial baffle in a 9-year-old patient with heterotaxy and an associated interrupted inferior vena, which required a transhepatic approach. Coronary angiography helped direct the Brockenbrough needle across the obstruction. Eighteen months post intervention, transthoracic echocardiography confirmed stent patency.
