{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T15:51:54Z","timestamp":1774885914263,"version":"3.50.1"},"reference-count":10,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T00:00:00Z","timestamp":1773792000000},"content-version":"vor","delay-in-days":17,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Catheter ablation for atrial fibrillation (AF) in patients with dextrocardia, complete situs inversus, and interrupted inferior vena cava is technically demanding because of mirror-image cardiac anatomy and the absence of femoral venous access. Pulsed field ablation (PFA), a nonthermal and tissue-selective modality, may offer advantages in such challenging conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>A 53-year-old man with dextrocardia, complete situs inversus, and interrupted inferior vena cava with azygos continuation had previously undergone catheter ablation via the internal jugular vein. Three years later, recurrent symptomatic persistent AF led to repeat ablation. Using a superior approach under general anaesthesia, transseptal puncture was guided by intracardiac echocardiography. Electroanatomical mapping identified conduction gaps in the right pulmonary veins. A variable-loop circular catheter was used to eliminate the gaps. Posterior left atrial wall isolation was additionally performed to address the substrate for persistent AF. The procedure was completed without fluoroscopy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>To the best of our knowledge, this is the first report of AF ablation using a multielectrode variable-loop circular catheter via a superior approach without fluoroscopy. This strategy demonstrated the feasibility of PFA in the presence of mirrored cardiac anatomy. Impedance-based catheter-to-tissue contact assessment and lesion-visualization tools supported precise and acute lesion formation without fluoroscopy. These features emphasize the usefulness of pulsed field ablation when femoral venous access is limited.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytag213","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T08:26:03Z","timestamp":1773822363000},"source":"Crossref","is-referenced-by-count":0,"title":["Pulsed field ablation using a multielectrode variable-loop circular catheter via a superior approach in a patient with dextrocardia, situs inversus, and interrupted inferior vena cava: a case report"],"prefix":"10.1093","volume":"10","author":[{"given":"Yohei","family":"Kikuchi","sequence":"first","affiliation":[{"name":"Heart Rhythm Center, Department of Cardiovascular Medicine, Sendai Kosei Hospital , 1-20 Tsutsumidori-Amamiyamachi, Aoba-ku, Sendai-shi, Miyagi 981-0914 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yosuke","family":"Mizuno","sequence":"additional","affiliation":[{"name":"Heart Rhythm Center, Department of Cardiovascular Medicine, Sendai Kosei Hospital , 1-20 Tsutsumidori-Amamiyamachi, Aoba-ku, Sendai-shi, Miyagi 981-0914 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daiki","family":"Kumazawa","sequence":"additional","affiliation":[{"name":"Heart Rhythm Center, Department of Cardiovascular Medicine, Sendai Kosei Hospital , 1-20 Tsutsumidori-Amamiyamachi, Aoba-ku, Sendai-shi, Miyagi 981-0914 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kosuke","family":"Onodera","sequence":"additional","affiliation":[{"name":"Heart Rhythm Center, Department of Cardiovascular Medicine, Sendai Kosei Hospital , 1-20 Tsutsumidori-Amamiyamachi, Aoba-ku, Sendai-shi, Miyagi 981-0914 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5630-1975","authenticated-orcid":false,"given":"Kennosuke","family":"Yamashita","sequence":"additional","affiliation":[{"name":"Heart Rhythm Center, Department of Cardiovascular Medicine, Sendai Kosei Hospital , 1-20 Tsutsumidori-Amamiyamachi, Aoba-ku, Sendai-shi, Miyagi 981-0914 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,3,18]]},"reference":[{"key":"2026033011020936000_ytag213-B1","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1016\/j.ejrad.2006.11.028","article-title":"Interruption or congenital stenosis of the inferior vena cava: Prevalence, imaging, and clinical findings","volume":"62","author":"Koc","year":"2007","journal-title":"Eur J Radiol"},{"key":"2026033011020936000_ytag213-B2","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/S0167-5273(02)00539-9","article-title":"Dextrocardia: an analysis of cardiac structures in 125 patients","volume":"88","author":"Garg","year":"2003","journal-title":"Int J Cardiol"},{"key":"2026033011020936000_ytag213-B3","doi-asserted-by":"crossref","first-page":"877","DOI":"10.26599\/1671-5411.2023.12.004","article-title":"Catheter ablation of atrial fibrillation via retrograde aortic approach in a patient with interrupted inferior vena cava: a case report","volume":"20","author":"Liu","year":"2023","journal-title":"J Geriatr Cardiol"},{"key":"2026033011020936000_ytag213-B4","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1016\/j.hrcr.2020.03.011","article-title":"Direct hepatic vein puncture and transseptal access for atrial flutter and fibrillation ablation in a patient with prior ligation of the inferior vena cava","volume":"6","author":"Suryanarayana","year":"2020","journal-title":"HeartRhythm Case Rep"},{"key":"2026033011020936000_ytag213-B5","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1016\/j.jacep.2019.10.019","article-title":"Radiofrequency-assisted transseptal access for atrial fibrillation ablation via a superior approach","volume":"6","author":"Liang","year":"2020","journal-title":"JACC Clin Electrophysiol"},{"key":"2026033011020936000_ytag213-B6","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1016\/j.hrcr.2024.03.014","article-title":"Back flip technique for pulmonary vein isolation: a case of radiofrequency ablation for paroxysmal atrial fibrillation in a patient with dextrocardia, situs inversus, and interrupted inferior vena cava","volume":"10","author":"Mizuno","year":"2024","journal-title":"HeartRhythm Case Rep"},{"key":"2026033011020936000_ytag213-B7","doi-asserted-by":"crossref","first-page":"1174","DOI":"10.1161\/CIRCULATIONAHA.124.070333","article-title":"Pulsed field ablation to treat paroxysmal atrial fibrillation: safety and effectiveness in the AdmIRE pivotal trial","volume":"150","author":"Reddy","year":"2024","journal-title":"Circulation"},{"key":"2026033011020936000_ytag213-B8","doi-asserted-by":"crossref","first-page":"ytaf577","DOI":"10.1093\/ehjcr\/ytaf577","article-title":"Pulsed field ablation of atrial fibrillation via jugular transseptal puncture in a patient with dextrocardia and interrupted inferior vena cava: a case report","volume":"9","author":"Scaglione","year":"2025","journal-title":"Eur Heart J Case Rep"},{"key":"2026033011020936000_ytag213-B9","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1111\/jce.70194","article-title":"Evaluation of the impact of irrigation flow rate on clinical outcomes during pulsed field ablation","volume":"37","author":"Yamashita","year":"2026","journal-title":"J Cardiovasc Electrophysiol"},{"key":"2026033011020936000_ytag213-B10","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1016\/j.hrcr.2025.02.012","article-title":"Recurrent atrial fibrillation ablation in a patient with an interrupted inferior vena cava and persistent left superior vena cava using pulsed field ablation","volume":"11","author":"Yamashita","year":"2025","journal-title":"HeartRhythm Case Rep"}],"container-title":["European Heart Journal - Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcr\/advance-article-pdf\/doi\/10.1093\/ehjcr\/ytag213\/67386377\/ytag213.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/10\/3\/ytag213\/67386377\/ytag213.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/10\/3\/ytag213\/67386377\/ytag213.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T15:02:18Z","timestamp":1774882938000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcr\/article\/doi\/10.1093\/ehjcr\/ytag213\/8527084"}},"subtitle":[],"editor":[{"given":"Henrike Aenne Katrin","family":"Hillmann","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Sebastian","family":"Feickert","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Felix","family":"Wiedmann","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Deepti","family":"Ranganathan","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":10,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3,2]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjcr\/ytag213","relation":{},"ISSN":["2514-2119"],"issn-type":[{"value":"2514-2119","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,3]]},"published":{"date-parts":[[2026,3]]},"article-number":"ytag213"}}