Percutaneous transhepatic venous access for atrial tachyarrhythmia ablation in patients with single ventricle and interrupted inferior vena cava

Abstract

Patients with congenital heart disease (CHD) who have undergone corrective and/or palliative surgery are at risk of developing different types of tachyarrhythmias, and their invasive management can represent a challenge to the electrophysiologist because of their complex anatomy, extensive surgical reconstructions, and use of intracardiac and extracardiac baffles and shunts, which limit conventional access to the cardiac chambers.1 In cases in which there are interruptions or anomalies of the inferior vena cava (IVC), a superior approach or a retrograde aortic arterial access to gain entry into the cardiac chambers may be used, but catheter stability and manipulation can prove very difficult in comparison with a standard femoral venous approach.2–7 KEY TEACHING POINTS Percutaneous transhepatic access is a safe and feasible method for atrial tachyarrhythmia ablation in patients with complex congenital heart disease and interrupted inferior vena cava. The use of long steerable sheaths via percutaneous transhepatic venous access greatly improves catheter stability and manipulation during mapping and ablation of atrial tachyarrhythmias. Percutaneous transhepatic venous access is an alternative in patients with no inferior venous access into the heart. Case studies of patients undergoing various cardiac interventions have reported complication rates of less than 5% using this approach.8,9 Although most cases have been reported in the pediatric population, there is some published data in adult patients.1–3 We present the case of an adult woman with complex CHDwhounderwent ablation of atrial tachyarrhythmias using a transhepatic venous access after failed antiarrhythmic drug therapy.