case_images: PMC11776092_01
case_images: (A) Computed tomography (CT) three-dimensional (3D) reconstruction of the heart (RA, right atrium; LA, left atrium); (B) CT 3D reconstruction of the heart (LAA, left atrial appendage, LV, left ventricle, PV, pulmonary vein, RA, right atrium, and RV, right ventricle); (C) CT 3D reconstruction of the left atrium.
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case_images: PMC11776092_01_fcvm-11-1525387-g001.jpg
case_images: F1
case_images: An 85-year-old male patient with dextrocardia (Figure 1) was hospitalized 4 years ago due to cerebral infarction, during which an electrocardiogram revealed AF.
case_images: Electrocardiogram of a patient with atrial fibrillation.
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case_images: PMC11776092_01_fcvm-11-1525387-g002.jpg
case_images: F2
case_images: A 24 hour Holter electrocardiogram confirmed persistent AF (Figure 2).
case_images: (A) X-ray image of the first transseptal (TS) puncture at position A-P; (B) X-ray image of the second TS puncture, taken at a 180  mirror image; (C) Intracardiac echocardiography (ICE) image of the first TS puncture; and (D) ICE image of the second TS puncture.
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case_images: PMC11776092_01_fcvm-11-1525387-g003.jpg
case_images: F3
case_images: TS punctures. The needle tip was directed toward the patient's leg at 10-11 o'clock, contrary to the usual 4-5 o'clock direction, with the puncture site confirmed under a 45  left anterior oblique view and ICE (Figure 3). Therefore, we used the VIZIGO bidirectional adjustable bent sheath; and (2) we adjusted the angiographic system settings to achieve a 180  mirror image (Figure 3).
case_images: (A) Left atrial electroanatomical map during atrial fibrillation; (B) ablation map.
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case_images: F4
case_images: A Pentaray electrode was used to construct the electroanatomical voltage mapping of the LA and pulmonary veins (Figure 4A). Bilateral pulmonary vein isolation was performed during AF (Figure 4B), and no pulmonary vein potentials were detected after a 30 min observation period.
case_images: No peridevice leaks were detected after the procedure, as shown in x-ray (A) and intracardiac echocardiography (B).
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case_images: F5
case_images: Both final angiographic and ICE results were excellent, with no peridevice leaks detected after the procedure (Figure 5).
case_images: The electrocardiogram of the patient remained in sinus rhythm 3 months after the procedure.
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case_images: PMC11776092_01_fcvm-11-1525387-g006.jpg
case_images: F6
case_images: At the 3-month follow-up, the patient remained in sinus rhythm (Figure 6) with no postoperative complications.