RESUMO
BACKGROUND: Radiofrequency cathether ablation (RFCA) of Atrial Fibrillation (AFib) and typical atrial flutter (AF) is traditionally performed via femoral vein approach and all devices are designed to be delivered via inferior access. In rare cases of congenital or iatrogenic obstruction of inferior vena cava (IVC), RFCA of arrhythmias is performed via transhepatic approach. CASE REPORT: 87 year old male patient with history of IVC filter placement for recurrent deep venous thrombosis and AFib on amiodarone developed symptoms with worsening Afib burden resulting in deterioration of left ventricular ejection fraction.Due to highly symptomatic pharmacological uncontrolled AFib, RFCA was decided in order to achieve long term success in restoring normal sinus rhythm. Transesophageal echocardiography on the day of procedure excluded clot or thrombus. Right femoral vein cannulation was performed, but advancing the guidewire through the IVC was extremely difficult. Peripheral venography revealed complete occlusion of the venous system with no flow through the IVC filter.We present you a case report of pulmonary vein isolation succesfully performed via the left subclavian vein. CONCLUSION: To the best of our knowledge, this is the first case report of the following: (a) successful transseptal puncture in a patient with persistent AFib and complete iatrogenic obstruction of the IVC using a Baylis wire through superior access without any complications, (b) PVI and typical AF ablation via superior approach using a bidirectional contact sensing ablation catheter; monitoring of the contact force in this case being extremely practical and (c) use of Vascade sheath for closure of the left axillary vein.