Successful atrioventricular junction ablation in a patient with situs inversus with dextrocardia and complex venous anatomy

Situs inversus with dextrocardia is an uncommon condition and is present in approximately 0.02% of the general population. Infrahepatic interruption of the inferior vena cava (IVC) is a congenital anomaly found in 1.3%–3.0% of patients with congenital heart disease, and it occurs in 8– 18% of patients with dextrocardia. In this condition, the IVC is interrupted above the renal branches, and systemic venous flow from below the interruption usually drains into the superior vena cava (SVC) via an enlarged azygos vein. Radiofrequency ablation of the atrioventricular node (AVN) is the most definitive rate-control strategy for patients with refractory atrial fibrillation. Although there are prior reports of radiofrequency ablation of cardiac arrhythmias via the anomalous IVC and azygos continuation, to the best of our knowledge this is the first case report of successful catheter ablation of the AVN in patients with dextrocardia, situs inversus, persistent bilateral SVC, and abnormal IVC.