Transhepatic venous access for catheter ablation of right and left side atrial arrhythmias in adults: challenges and outcomes.

Introduction: Electrophysiologic (EP) procedures are typically performed via the femoral venous system, but in some patients, the inferior vena cava (IVC) is unavailable. The hepatic vein has emerged as a viable alternative to femoral access, providing an inferior route that accommodates large sheaths required for better catheter manipulation. Although the percutaneous transhepatic approach has been used successfully in the pediatric population, its use in adults is scarce, with a complication rate of approximately 5%.

Methods And Results: Three patients with limited venous access were referred for ablation between 2018 and 2021. The percutaneous transhepatic access approach provided good support for the EP study, electro-anatomical mapping, and effective radiofrequency ablation of right and left-side arrhythmias. No significant complications were documented, and all patients were discharged within 48 hours of the procedure. At follow-up, all patients had excellent arrhythmia control without significant adverse events.

Conclusion: Percutaneous transhepatic access is a feasible and safe alternative to femoral venous access for EP procedures in adult patients with limited venous access.