Hepatico-tricuspid isthmus ablation for typical-like atrial flutter by femoral approach in absence of the inferior vena cava: use of magnetic navigation and three-dimensional mapping with image integration

Abstract

The previously unknown congenital absence of inferior vena cava, an otherwise benign condition, may create difficulties for catheter ablation of arrhythmias. We describe a case of a typical-like atrial flutter, in which magnetic navigation was important for conserving the femoral approach. Electroanatomic mapping with image integration helped define the critical isthmus between the ostia of the suprahepatic veins and the tricuspid valve.