Radiofrequency catheter ablation of the slow pathway for atrioventricular nodal reentry in a patient with an obstructed inferior vena cava.

A 51-year-old man with an obstructed inferior vena cava underwent successful slow pathway catheter ablation using a superior venous approach. Two central venous sheaths were introduced into the right internal jugular vein using different approaches (anterior and posterior), so the two sheaths located away from each other could prevent the catheters from 'sticking' to one another. The transseptal long sheath enabled a stable positioning of the ablation catheter. A nonfluoroscopic mapping system could reduce radiation exposure to the ablator. These techniques may be useful to overcome the disadvantages of the superior venous approach compared to the inferior venous approach.