Managing difficult anatomy: remote-controlled ablation of atrioventricular nodal reentry tachycardia in a patient with agenesis of the inferior vena cava

Autor: Björn Buchter, Dmitrij Velikan, Burkhard Hügl, Zdravena Findeisen
Rok vydání: 2013
Předmět:
Zdroj: Clinical Research in Cardiology. 102:687-691
ISSN: 1861-0692
1861-0684
Popis: Radiofrequency catheter modification of the slow pathway is the recommended therapy for patients suffering from recurrent symptomatic atrioventricular nodal reentry tachycardia. This procedure is usually performed via the femoral vein and inferior vena cava. Agenesis of the inferior vena cava is a rare congenital condition without clinical significance. However, this anomaly has a clinical impact when performing electrophysiology studies and ablations [1], and alternative venous approaches are used to treat these patients [2]. We report a successful remotecontrolled ablation of a slow pathway in a patient with atrioventricular nodal reentry tachycardia (AVNRT) and a congenitally absent inferior vena cava. A 46-year-old woman was referred to our institution for catheter ablation of recurrent supra-ventricular tachycardia (SVT) with suspicion of reentry circuits. The patient previously had antiarrhythmic drugs therapy and two unsuccessful attempts at catheter ablation of AVNRT using a femoral access, but these procedures were terminated due to congenital absence of the inferior vena cava (IVC). The second institution used angiographic CT to verify the complete agenesis of the IVC. Prior to the study, written informed consent was obtained. She was under continuous sedation by intravenous (i.v.) propofol and i.v. bolus fentanyl. A superior venous approach was utilized for the electrophysiological study, and access was obtained via the right subclavian vein. A short 6-Fr. sheath (St. Jude Medical, St. Paul, MN 55117-9983, USA) and short 8-Fr. sheath (Cordis, Bridgewater, NJ 08807, USA) were placed in the subclavian vein. A four-pole 5-Fr. Supreme (St. Jude Medical, St. Paul, MN 55117-9983, USA) catheter was introduced through the 6-Fr. sheath and positioned along the free wall in right atrium for high right atrium recordings. A celsius RMT non-irrigated tip catheter (Biosense Webster, Diamond Bar, CA 91765, USA) was advanced through the 8-Fr. sheath and placed in the right atrium for programmed stimulation and recording activation times at various anatomical sites during RA pacing to identify the slow pathway for ablation. Catheter placement in the RA was confirmed by X-ray and intracardiac electrocardiogram assessment. Due to low BMI of 19.4 and to avoid a complete pneumothorax two catheters via only one puncture B. Hugl (&) Department of Medicine, Division of Cardiology/Rhythmology, St. Mary’s Hospital, St. Elisabeth Hospital, Neuwied, Germany e-mail: Burkhard.Huegl@marienhaus.de
Databáze: OpenAIRE
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