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Case Reports
. 2025 Jan 24;11(4):343-346.
doi: 10.1016/j.hrcr.2025.01.009. eCollection 2025 Apr.

Azygos vein approach for radiofrequency ablation of para-Hisian atrial tachycardia in a patient with inferior vena cava interruption

Atsuhito Oda  1 , Yuichiro Sagawa  1 , Yumi Yasui  1 , Hirofumi Arai  1 , Kazuya Murata  1 , Kaoru Okishige  1 , Manabu Kurabayashi  1 , Yasuteru Yamauchi  1
Affiliations
Case Reports

Azygos vein approach for radiofrequency ablation of para-Hisian atrial tachycardia in a patient with inferior vena cava interruption

Atsuhito Oda et al. HeartRhythm Case Rep. .
No abstract available

Keywords: Azygous vein; Inferior vena cava; Interruption; Para-Hisian atrial tachycardia; Radiofrequency ablation.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Venography is performed by inserting a sheath into the right femoral vein. The inferior vena cava is absent (yellow arrowheads), the right common iliac vein is narrowed (red arrowheads), and collateral circulation begins with visualization of the left common femoral vein. The left common femoral vein is connected to the infrarenal inferior vena cava via the hemiazygos vein (pink arrowheads), which develops on the left side of the vertebrae.
Figure 2
Figure 2
A: An irrigated ablation catheter is advanced through the steerable sheath and located at the earliest activation site in the para-Hisian region. ABL = ablation catheter; CS = coronary sinus; LAO = left anterior oblique; RA = right atrium; RAO = right anterior oblique; RV = right ventricle. B: The earliest activation site is located in the para-His region, where atrial signals are detected 20 ms pre-QRS. No His potentials are recorded on the ablation catheter. C: Atrial tachycardia is terminated 2.3 seconds after radiofrequency ablation. ABL = ablation catheter; CS = coronary sinus; RA = right atrium; RV = right ventricle. D: The activation map during atrial tachycardia shows the locations where ablation is performed and His potentials are recorded. The red tag indicates the transiently successful ablation sites from the noncoronary cusp, and the white tag indicates the final successful ablation sites in the para-Hisian area. LAO = left anterior oblique; LL = left lateral; NCC = non-coronary cusp. E: The contact force data at the final successful ablation site show that the vector of contact between the catheter tip and tissue lacks any perpendicular component, consisting entirely of parallel vectors. LAO = left anterior oblique; LL = left lateral.
Figure 3
Figure 3
A postoperative 3D computed tomography scan shows that the infrahepatic segment of the inferior vena cava (IVC) is absent, and the infrarenal IVC begins with a developed azygos vein system, perfusing from the superior vena cava (SVC) to the right atrium. The hepatic veins are draining into the right atrium via the remaining thoracic IVC. The right common iliac vein is narrowed because of compression by the left common iliac artery. 3D = 3-dimensional; AP = anteroposterior; LAO = left anterior oblique.
See this image and copyright information in PMC

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