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\title{The Other Side of the Circulation: The Arterial Syste}



\author[1]{Serkan Cay}%
\author[1]{Ozcan Ozeke}%
\author[1]{Firat Ozcan}%
\author[1]{Serkan Topaloglu}%
\author[1]{Dursun Aras}%
\affil[1]{University of Health Sciences, Ankara City Hospital}%


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  \date{June 07, 2024}


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To the Editor,

We have read with great interest the article entitled `Management of
Patients with Interrupted Inferior Vena Cava Requiring Electrophysiology
Procedures' by Hanley et al\textsuperscript{1} in the latest issue of
the journal. We would like to thank the authors for their difficult case
series with interrupted vena cava inferior and for successfully
performed electrophysiologic studies. Electrophysiologic procedures
including mapping and percutaneous catheter ablation of left-sided
accessory pathways via the retrograde transaortic approach have been
successfully applied techniques in patients with supraventricular
tachycardia with and without Wolff-Parkinson-White electrocardiographic
pattern for a long time.\textsuperscript{2} If no anatomic obstacles are
found, a deflectable mapping catheter can easily be advanced from the
femoral artery and positioned in the mitral annulus to localize the
accessory pathway, even in patients with congenital
anomalies.\textsuperscript{3} One should keep in mind that the
retrograde transaortic approach has the potential adverse events related
to percutaneous arterial access and tight contact with valvular leaflets
although it seems as a simpler and less time consuming approach
requiring less specialized equipment compared to the transseptal way.

Mapping and percutaneous catheter ablation of the atrioventricular node
or the His bundle can also be performed from the left side via the
retrograde transaortic approach. Some electrophysiologists prefer the
retrograde transaortic route as a first-line approach although most
operators perform catheter ablation from the venous side.

The electrophysiologists' preferences are generally based on experience,
familiarity with the equipment and the procedure, and personal thoughts
about the patient.

\textbf{Keywords:} ablation; left-sided; retrograde transaortic approach

\textbf{Funding}

None.

\textbf{Conflict of interests}

The authors declare that there are no conflict of interests.

\textbf{References}

1 - Hanley A, Bode WD, Heist EK, et al. Management of patients with
interrupted inferior vena cava requiring electrophysiology
procedures.~\emph{J Cardiovasc Electrophysiol} . 2020;31(5):1083-1090.

2 - Tsai CF, Chen SA, Chiang CE, et al. Radiofrequency ablation-induced
asystole during transaortic approach for a left anterolateral accessory
pathway: a Bezold-Jarisch-like phenomenon.~\emph{J Cardiovasc
Electrophysiol} . 1997;8(6):694-699.

3 - Cay S, Ozcan F, Ozeke O, Aras D, Topaloglu S. Accessory pathway
ablation in a patient with situs inversus totalis and
Wolff-Parkinson-White electrocardiographic pattern: Mirror
approach.~\emph{Int J Cardiol} . 2015;193:34-35.

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