Content area
Full Text
Clin Res Cardiol (2013) 102:687691
DOI 10.1007/s00392-013-0587-9
LETTER TO THE EDITORS
Managing difcult anatomy: remote-controlled ablation of atrioventricular nodal reentry tachycardia in a patient with agenesis of the inferior vena cava
Burkhard Hgl Dmitrij Velikan Bjrn Buchter
Zdravena Findeisen
Received: 13 February 2013 / Accepted: 31 May 2013 / Published online: 15 June 2013 Springer-Verlag Berlin Heidelberg 2013
Keywords Electrophysiology Magnetic navigation
system Atrioventricular nodal reentry tachycardia
Catheter ablation
AbbreviationsAVNRT Atrioventricular nodal reentry tachycardia SVT Supra-ventricular tachycardiaIVC Inferior vena cavaVT Ventricular tachycardiaECG ElectrocardiogramRF Radio frequency
Sirs:
Radiofrequency catheter modication 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 signicance. 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 remote-controlled 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...