Caspian Journal of Internal Medicine

Background: Congenital anomalies can pose challenges during electrophysiology (EP) procedures in patients with tachyarrhythmias, making diagnosis and management of these cases quite difficult. An interrupted inferior vena cava, an uncommon congenital defect, is especially rare without associated congenital heart disease. In this setting, catheter ablation from femoral vein access becomes more challenging.
Case Presentation: A 23-year-old male with no cardiovascular risk factors or prior cardiovascular disease presented with atrioventricular reentrant tachycardia that converted to sinus rhythm after adenosine administration. The patient was scheduled for an electrophysiology study with catheter ablation if indicated. During the procedure, catheter advancement into the right atrium was unsuccessful, raising suspicion of an interrupted inferior vena cava (IVC). Radiofrequency ablation was subsequently performed successfully via the subclavian vein approach. Post-procedural computed tomography (CT) imaging confirmed interruption of the IVC.
Conclusion: Accessing via the subclavian vein can facilitate catheter ablation when an interrupted inferior vena cava is present.