Images and Case Reports in Arrhythmia and Electrophysiology Successful Transseptal Puncture and Cryoballoon Pulmonary Vein Isolation in Adverse Anatomy Interrupted Inferior Caval Vein and Azygos Continuation

A 56-year-old male patient was admitted for catheter ablation of highly symptomatic paroxysmal atrial fibrillation. During the procedure, a rare anatomic variation with an interrupted inferior caval vein (ICV) branching suprarenal into an azygos venous continuation draining into the superior caval vein was detected. Using angiography, a continuation of the ICV leading into the liver, subdividing into 5 smaller branches draining into the right atrium (RA), was displayed. Despite this challenging anatomic variation, successful pulmonary vein isolation (PVI) was performed.