Left Atrial Ablation of Atrial Fibrillation in a Patient with Dextrocardia: the Complexities of an Inverted Anatomy
This is a 70-year-old female patient with atrial fibrillation and dextrocardia with situs visceris inversus. Over the last 10 years, the patient had experienced recurrent episodes of paroxysmal atrial fibrillation triggered by ectopies with “P on T” aspect. The arrhythmia recurred in spite of the administration of antiarrhythmic drugs. Other than the abnormal position, no relevant structural heart disease was documented by transthoracic echocardiogram. A pre-procedural transoesophageal echocardiogram showed no intracavitary thrombus. Contrast-enhanced computed tomography, in addition to three-dimensional reconstruction of the heart and of the pulmonary veins, allowed visualisation of the inverted position of the peripheral veins, with a rectilinear course of the axis of the left femoral-left iliac vein, inferior vena cava and right atrium. For this reason, transseptal catheterisation was unusually planned through the left femoral vein. Antiarrhythmic drug therapy was withdrawn 1 week before the procedure and the arrhythmia was persistent at the time of the procedure.
KeywordsAtrial Fibrillation Pulmonary Vein Left Atrium Paroxysmal Atrial Fibrillation Antiarrhythmic Drug Therapy
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