In selected complex cases, the integration of electrophysiology and interventional cardiology is crucial for optimal patient care. The availability of adjacent EP and cath labs, along with skilled paramedical staff routinely working across both settings, enables the execution of truly hybrid procedures.

We recently treated a 65-year-old woman with a history of atrial fibrillation ablation performed at another center. She presented with a 2 cm atrial septal defect with a minimal aortic rim, recurrent atypical tachycardia-dependent flutter, significant left-to-right shunt, and signs of congestive heart and liver failure.

Under general anesthesia, we performed an ablation of the atypical flutter (RSPV–SVC circuit, targeted from both the pulmonary vein and the superior vena cava), followed by successful percutaneous ASD closure (performed by Dr. Paloscia) via the same femoral access. The procedure achieved an excellent acute outcome despite the challenging anatomy.
Stefano Guarracini Andrea Italiano Michele Di Mauro
Special thanks to Abbott (Stefano Vincenti) for their valuable support.