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Successful Cavotricuspid Isthmus Ablation in a Patient with an Interrupted Inferior Vena Cava and Persistent Left Superior Vena Cava.
MedLine Citation:
PMID:  25425487     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
A 46-year-old man with atrial flutter (AFL) underwent electrophysiologic testing. He had a history of a heterotaxy syndrome with a persistent left superior vena cava (PLSVC) that was draining via the coronary sinus (CS) into the morphologic right atrium, infrahepatic interruption in the inferior vena cava (IVC) with an azygous/hemiazygous continuation that was draining into the PLSVC, and surgical repair of a ventricular septal defect. At baseline, a typical AFL persisted (Figure 1). A decapolar catheter was positioned at the cavotricuspid isthmus (CTI) via a femoral approach through the azygos vein, PLSVC and CS (Figure 1). The atrial activation sequences at the CTI were from lateral to septal, and entrainment pacing at the CTI revealed that the post pacing interval equaled to the cycle length of the AFL. Based on these findings, the AFL was diagnosed as counter-clockwise CTI-dependent AFL. An 8 mm-tip ablation catheter was then positioned at the CTI via the same femoral approach as the decapolar catheter (Figure 1). A linear radiofrequency ablation was performed at the CTI, resulting in termination of the AFL. Following this, atrial pacing performed from the distal electrode pair of the ablation catheter that was positioned on the lateral side of the ablation line confirmed CTI conduction block by revealing that the atrial activation sequences were septal to lateral on the septal side of the ablation line (Figure 2). During a follow-up period of more than 6 months, the patient has been free from any AFL recurrences without any antiarrhythmic drugs. No complications occurred. This article is protected by copyright. All rights reserved.
Authors:
Takumi Yamada; Yung R Lau; G Neal Kay
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-11-26
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  -     ISSN:  1540-8167     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2014 Nov 
Date Detail:
Created Date:  2014-11-26     Completed Date:  -     Revised Date:  2014-11-27    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
This article is protected by copyright. All rights reserved.
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