Feasibility of complex transfemoral electrophysiology procedures in patients with inferior vena cava filters

Background The presence of inferior vena cava filters (IVCFs) has been considered a relative contraindication to electrophysiology (EP) procedures that require transfemoral venous placement of multiple catheters and/or long sheaths. There are inadequate data related to complex EP procedures in this population. Objective The purpose of this study was to describe the experience of a single high-volume center with respect to complex EP procedures in patients with IVCFs. Methods Patients with IVCFs undergoing complex EP procedures between 2004 and 2018 were identified. Clinical characteristics, IVCF type, procedural findings, and complications were analyzed. Results Fifty complex ablation procedures were performed in 40 patients (mean age 63.8 ± 10.9 years; 68% men). The mean IVCF dwell time was 69.1 ± 19.1 months, and 96% of patients were on chronic oral anticoagulation. Procedures included ablation of atrial fibrillation (21), ventricular tachycardia (20), supraventricular tachycardia (3), cavotricuspid isthmus flutter (3), supraventricular tachycardia and cavotricuspid isthmus flutter (1), and transvenous lead extraction (3). Twenty procedures included quadripolar catheters (mean 1.4 ± 0.75), and 33 procedures involved deflectable decapolar catheters (mean 1.7 ± 0.47). Long sheaths were used in 35 cases (mean 1.63 ± 0.49) and intracardiac echocardiography in 38. In 4 cases (involving 3 patients), the IVCF was occluded and could not be crossed. There were no procedural complications related to the IVCF. Conclusion The substantial majority of IVCFs in patients presenting for complex EP procedures were patent and easily crossed under fluoroscopic guidance. The presence of an IVCF should not discourage operators from performing procedures that require transfemoral deployment of multiple catheters and/or sheaths.