Successful robotic pulmonary vein isolation in adverse anatomy: dextrocardia with situs solitus, D-loop ventricles, and normally related great arteries

Abstract

A 46-year-old female was referred for catheter ablation of symptomatic, drug-refractory atrial fibrillation (AF). Left atrial diameter was 52 mm. Chest radiography demonstrated the right-sided heart ( Panel A ). Cardiac magnetic resonance imaging classified this as dextrocardia (base to apex pointing to the right) with situs solitus (normal visceral situs with concordant atrial situs, Panel B ). The morphological right ventricle, identified by the presence of the moderator band, coarse apical trabeculations, and infundibulum, was connected to the right atrium (concordant atrioventricular connections) confirming normal so-called D-loop ventricular development and orientation ( Panel C ). Ventriculo-arterial connections were also concordant (aorta located left and posterior to pulmonary artery). Circumferential pulmonary vein (PV) isolation was performed for the treatment of AF. Double …