Cryoablation of an anteroseptal acces-sory pathway through the jugular and subclavian veins in a patient withinterruption of the inferior vena cava

Abstract

Interruption of the inferior vena cava (IVC) is a rare entity, usually accompanied by azygos or hemiazygos continuation. Venous blood from the caudal part of the body reaches the heart via the azygos vein and superior vena cava. Interruption of the IVC with azygos continuation is seen in 0.6% of patients with congenital heart disease and less than 0.3% of individuals without any other variations or anomalies (1). The importance of this anomaly is that it may coexist with congenital heart defects and may interfere with catheter manipulation. On the other hand, ablation of anteroseptally located accessory pathways can be challenging because of the increased risk of atrioventricular (AV) block. This report presents successful cryoablation of an anteroseptal accessory pathway through the jugular and subclavian veins in a young adult with interrupted inferior vena cava and azygos continuation, in whom the femoral approach was not possible due to the helix-like structure of the azygos system.