Percutaneous transhepatic access for catheter ablation of a patient with heterotaxy syndrome complicated with atrial fibrillation: A case report

Figure 1 Serial fluoroscopic still frames during the procedure. A: Electrocardiogram before the operation; B: JR4.0 catheter was inserted into the hepatic vein via the superior vena cava and then a contrast agent was injected to determine the main direction of the hepatic vein; C: Hepatic access was obtained under the guidance of angiography; D: A 0.035-inch Bentson wire was placed through the needle into the right atrium.

Figure 2 Visualization of the interatrial septal puncture. A: Interatrial septal puncture under the guidance of intracardiac echocardiography (ICE), and the procedure presented a tent-like shape visualized by an orange line; B: ICE image: The ablation catheter in the left atrium, single access was obtained for the ablation; C: Anatomy of the heart at the right anterior view and the right view.

Figure 3 Electroanatomic map obtained during procedure. A: Hepatic signal position is visualized by a green color; B: Left atrial electroanatomic map and pulmonary vein isolation radiofrequency ablation lesions; C: Electrocardiogram after the operation.