Ablation of atrioventricular nodal reentrant tachycardia using the superior approach in a patient with IVC interruption

摘要

A 39-year-old female with recurrent palpitations and documented narrow complex tachycardia was referred for electrophysiology study and ablation. Abnormal course of catheters placed from the femoral vein suggested a diagnosis of interruption of the inferior vena cava (IVC) with azygous continuation and this was confirmed with venography. Two 5 French quadripolar catheters (Supreme, St. Jude Medical, St. Paul, MN, USA) were negotiated through the azygous vein and positioned in the right atrium and right ventricle, respectively. A deflectable 6 French quadripolar catheter (Biosense Webster, Diamond Bar, CA, USA) was positioned across the tricuspid valve to record the His bundle electro-gram (Fig. 1). Typical slow-fast atrioventricular nodal reentrant tachycardia was induced with single atrial extrastimuli during isoprenaline infusion. A 4-mm tip ablation catheter (Therapy, St. Jude Medical) was introduced through the right internal jugular vein for mapping and ablation in the slow pathway region. Junctional beats were elicited during ablation and postablation, no echo beats or sustained tachycardia were induced with atrial programmed stimulation during isoprenaline infusion.