{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T15:22:33Z","timestamp":1789140153110,"version":"build-2803163510"},"reference-count":5,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2021,7,7]],"date-time":"2021-07-07T00:00:00Z","timestamp":1625616000000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Cryoballoon-based pulmonary vein isolation (cbPVI) is a standardized treatment of atrial fibrillation. In complex anatomies, radiofrequency ablation (rfPVI) is usually preferred. We describe the first cbPVI in a rare patient with SI and levocardia.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>A 41-year-old male patient with paroxysmal atrial fibrillation was referred to our clinic after a previous, unsuccessful cbPVI procedure. Observation of an atypical lead-wire position due to an abnormal anatomy of the inferior vena cava led to its initial termination. A subsequent thoraco-abdominal computed tomography revealed situs inversus abdominalis and levocardia and the procedure was re-attempted in our clinic. Transseptal puncture (TSP) was guided via transoesophageal echocardiography and fluoroscopy, using a SL0-Sheath and a standard BRK-needle. Advancement of the sheath initially failed but after additional dilatation with an Inoue\u00ae dilator, transseptal passage of the sheath was successful. Due to the unusual antero-cranial TSP, the septal pulmonary veins (PV) contrasted poorly. After repeat TSP, a steerable FlexCath Advance\u00ae sheath was introduced into the left atrium using an Amplatz Super Stiff\u00ae guidewire. Subsequently, all PV were intubated with the Achieve\u00ae catheter, over which a 2nd generation cryoballoon was introduced. Despite the practical challenges in this case, all PV were isolated.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>The main challenges include the achievement of transseptal access and manipulation of the cryoballoon to achieve a patent seal of the pulmonary veins. cbPVI eliminates the need for constant re-positioning of the ablation catheter and might facilitate the creation of durable lesions under such difficult anatomical conditions.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytab245","type":"journal-article","created":{"date-parts":[[2021,7,7]],"date-time":"2021-07-07T06:04:21Z","timestamp":1625637861000},"source":"Crossref","is-referenced-by-count":1,"title":["A case report of cryoballoon-based pulmonary vein isolation in a patient with situs inversus abdominalis and levocardia"],"prefix":"10.1093","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9738-4685","authenticated-orcid":false,"given":"Omar","family":"Anwar","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Department of Cardiology, Asklepios Clinic St. Georg, Semmelweis University Campus Hamburg, Lohm\u00fchlenstrasse 5, 20099 Hamburg, Germany"},{"name":"DZHK (German Center for Cardiovascular Research), Partner Site Hamburg\/Kiel\/Luebeck, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0022-9385","authenticated-orcid":false,"given":"Tobias","family":"Espersen","sequence":"additional","affiliation":[{"name":"Department of Cardiac Electrophysiology, Heart and Vascular Centre, University Hospital Hamburg Eppendorf, Hamburg, Germany"},{"name":"Department of Cardiology, Klinikum Nordfriesland\u2014Klinikum Husum, Husum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8890-5749","authenticated-orcid":false,"given":"Stephan","family":"Willems","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Cardiology, Asklepios Clinic St. Georg, Semmelweis University Campus Hamburg, Lohm\u00fchlenstrasse 5, 20099 Hamburg, Germany"},{"name":"DZHK (German Center for Cardiovascular Research), Partner Site Hamburg\/Kiel\/Luebeck, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5458-9688","authenticated-orcid":false,"given":"Christian","family":"Eickholt","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Cardiology, Asklepios Clinic St. Georg, Semmelweis University Campus Hamburg, Lohm\u00fchlenstrasse 5, 20099 Hamburg, Germany"},{"name":"DZHK (German Center for Cardiovascular Research), Partner Site Hamburg\/Kiel\/Luebeck, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,7,7]]},"reference":[{"key":"2021070817020218600_ytab245-B1","doi-asserted-by":"crossref","first-page":"1725","DOI":"10.1093\/europace\/eus325","article-title":"Pulmonary vein isolation in a patient with dextrocardia","volume":"14","author":"Chong","year":"2012","journal-title":"Europace"},{"key":"2021070817020218600_ytab245-B2","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1016\/j.joa.2016.03.005","article-title":"Successful cryoballoon pulmonary vein isolation in a patient with situs inversus and dextrocardia","volume":"32","author":"Yoshiga","year":"2016","journal-title":"J Arrhythm"},{"key":"2021070817020218600_ytab245-B3","doi-asserted-by":"crossref","first-page":"1120","DOI":"10.1093\/europace\/eun165","article-title":"Successful catheter ablation of atrial fibrillation in a patient with dextrocardia","volume":"10","author":"Yamada","year":"2021","journal-title":"Europace"},{"issue":"3","key":"2021070817020218600_ytab245-B4","doi-asserted-by":"publisher","first-page":"361","DOI":"10.7863\/jum.2007.26.3.361","article-title":"Isolated levocardia: prenatal diagnosis, clinical importance, and literature review","volume":"26","author":"Gindes","year":"2007","journal-title":"J Ultrasound Med"},{"key":"2021070817020218600_ytab245-B5","doi-asserted-by":"crossref","first-page":"2235","DOI":"10.1056\/NEJMoa1602014","article-title":"Cryoballoon or radiofrequency ablation for paroxysmal atrial fibrillation","volume":"374","author":"Kuck","year":"2016","journal-title":"N Engl J Med"}],"container-title":["European Heart Journal - Case Reports"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ehjcr\/article-pdf\/5\/7\/ytab245\/38876551\/ytab245.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ehjcr\/article-pdf\/5\/7\/ytab245\/38876551\/ytab245.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,9]],"date-time":"2021-07-09T00:58:36Z","timestamp":1625792316000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcr\/article\/doi\/10.1093\/ehjcr\/ytab245\/6316559"}},"subtitle":[],"editor":[{"given":"Richard","family":"Ang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Robert","family":"Sch\u00f5nbauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"David","family":"Niederseer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Gemina","family":"Doolub","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Katharine","family":"Kott","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,7,1]]},"references-count":5,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2021,7,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjcr\/ytab245","relation":{},"ISSN":["2514-2119"],"issn-type":[{"value":"2514-2119","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,7,1]]},"published":{"date-parts":[[2021,7,1]]},"article-number":"ytab245"}}