Adams CD, Tapias CA, Rodriguez DA, Cabrera JS, Hernandez BM, Bautista WF, Saenz LC. Transhepatic venous access for catheter ablation of right and left side atrial arrhythmias in adults: challenges and outcomes.
Curr Probl Cardiol 2025;
50:102986. [PMID:
39863006 DOI:
10.1016/j.cpcardiol.2025.102986]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2025] [Accepted: 01/16/2025] [Indexed: 01/27/2025]
Abstract
INTRODUCTION
Electrophysiologic (EP) procedures are typically performed via the femoral venous system, but in some patients, the inferior vena cava (IVC) is unavailable. The hepatic vein has emerged as a viable alternative to femoral access, providing an inferior route that accommodates large sheaths required for better catheter manipulation. Although the percutaneous transhepatic approach has been used successfully in the pediatric population, its use in adults is scarce, with a complication rate of approximately 5 %.
METHODS AND RESULTS
Three patients with limited venous access were referred for ablation between 2018 and 2021. The percutaneous transhepatic access approach provided good support for the EP study, electro-anatomical mapping, and effective radiofrequency ablation of right and left-side arrhythmias. No significant complications were documented, and all patients were discharged within 48 h of the procedure. At follow-up, all patients had excellent arrhythmia control without significant adverse events.
CONCLUSION
Percutaneous transhepatic access is a feasible and safe alternative to femoral venous access for EP procedures in adult patients with limited venous access.
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