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Case Reports
. 2023 May 20;23(1):265.
doi: 10.1186/s12872-023-03308-6.

Robotic magnetic navigation-guided pulmonary vein isolation in an atrial fibrillation patient with dextrocardia situs inversus: techniques and potential advantages

Qingzhi Luo  1 , Yun Xie  1 , Liqun Wu  1 , Qi Jin  2
Affiliations
Case Reports

Robotic magnetic navigation-guided pulmonary vein isolation in an atrial fibrillation patient with dextrocardia situs inversus: techniques and potential advantages

Qingzhi Luo et al. BMC Cardiovasc Disord. .

Abstract

Background: Dextrocardia with situs inversus (DSI) is a very rare congenital anomaly. Catheter manipulation and ablation of atrial fibrillation (AF) in patients with this anatomical variant is challenging for the operators. This case report presents a safe and effective AF ablation guided by the robotic magnetic navigation (RMN) system in combination with intracardiac echocardiograhy (ICE) in a patient with DSI.

Case presentation: A 64-year-old male with DSI was referred for catheter ablation of symptomatic, drug-refractory paroxysmal AF. One transseptal access was achieved via the left femoral vein under the guidance of ICE. The three-dimensional reconstruction of the left atrium and the pulmonary veins (PVs) were performed by the magnetic catheter using the CARTO and the RMN system. Then, the electroanatomic map and pre-acquired CT images were merged. Finally, bilateral circumferential ablation lines were delivered around the ipsilateral PV ostia to achieve complete PV isolation (PVI).

Conclusions: This case demonstrates that AF catheter ablation under the guidance of the RMN system using ICE is feasible and safe in a patient with DSI. Moreover, the combination of these technologies broadly facilitates treatment of patients with complex anatomy, while reducing the risk of complications.

Keywords: Atrial fibrillation; Case report; Catheter ablation; Dextrocardia situs inversus; Robotic magnetic navigation.

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Conflict of interest statement

The authors’ declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Panel A Chest radiograph reveals DSI with left-sided liver and right-sided stomach. Panel B Cardiac CT scan shows the inferior and superior vena cava connecting to the RA on the left side, and the structure and position of all four cardiac chambers presents a mirror image of a normal heart.Panel C The 3D anatomical reconstruction of the LA acquired with ICE is merging with reconstructions by the ablation catheter in the RMN system. Panel D The magnetic ablation catheter is positioned in the left inferior PV in RAO view, with a multipolar electrode catheter in CS and ICE catheter at mid-RA. Panel E The magnetic ablation catheter along with the steerable sheath forms a large loop in LA when ablating right PV in RAO view. Panel F The 3D electroanatomical reconstruction of the LA and PVs is created using the CARTO and RMN system, merging with pre-acquired CT image. Red dots indicate the ablation line around the bilateral PVs
See this image and copyright information in PMC

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