Complexities in Managing Wolf-Parkinson-White Syndrome: A Case of Congenital Inferior Vena Cava Anomaly With Azygos Continuation.

Autor:	Rivera-Martinez JC; Internal Medicine, Lakeland Regional Health, Lakeland, USA., Johnson T; Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA., Ahmed S; Cardiology, Lakeland Regional Health, Lakeland, USA.
Jazyk:	angličtina
Zdroj:	Cureus [Cureus] 2024 Sep 14; Vol. 16 (9), pp. e69426. Date of Electronic Publication: 2024 Sep 14 (Print Publication: 2024).
DOI:	10.7759/cureus.69426
Abstrakt:	The inferior vena cava (IVC) is a critical structure for venous return to the heart, and congenital anomalies of the IVC, though rare, can have significant clinical implications during procedures like catheter ablation for arrhythmias. In this case, a 26-year-old male presented with left-sided chest pressure after a routine exercise. Electrocardiography (ECG) revealed a delta wave and shortened PR interval, consistent with Wolf-Parkinson-White (WPW) syndrome, which involves an accessory electrical pathway leading to supraventricular tachycardia. Catheter ablation was planned to treat WPW syndrome; however, during the procedure, access to the right atrium via the IVC was obstructed due to an undiagnosed congenital IVC anomaly. Imaging revealed that the IVC was interrupted at the abdominal level, with venous return rerouted through an enlarged azygos vein into the superior vena cava. This anomaly prevented the use of the standard transvenous approach for ablation, and alternative approaches requiring specialized equipment and a highly skilled team available only at a tertiary care center were necessary. The patient was subsequently referred to such a center for further management. The IVC anomaly directly affected the procedural outcome, making pre-procedural imaging important when unexpected difficulties arise during ablation for WPW. This case demonstrates how congenital vascular anomalies may complicate standard electrophysiological procedures, especially in arrhythmia management. Future research should focus on developing alternative ablation techniques, such as the aortic approach, which may offer solutions for patients with vascular anomalies but require specialized facilities. While routine imaging for all WPW patients is not necessary, this case suggests that early imaging should be considered when procedural access is unexpectedly difficult. Establishing protocols and training for these complex scenarios is important for improving outcomes in similar cases. Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. (Copyright © 2024, Rivera-Martinez et al.)
Databáze:	MEDLINE
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