An atrial flutter in a 40-year-old woman with situs inversus, transposition of the great arteries, atrial switch, and interruption of the inferior vena.

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Presentation transcript:

An atrial flutter in a 40-year-old woman with situs inversus, transposition of the great arteries, atrial switch, and interruption of the inferior vena cava Judith Bouchardy, MD, Tobias Rutz, MD, Stefano Di Bernardo, MD, Milan Prsa, MD, Pierre Monney, MD, Etienne Pruvot, MD HeartRhythm Case Reports Volume 2, Issue 2, Pages 159-163 (March 2016) DOI: 10.1016/j.hrcr.2015.12.008 Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 1 Electrocardiogram recordings. A: Atrial flutter characterized by negative F waves in inferior leads and positive ones in lead V1. B: Sinus rhythm in alternance with junctional rhythm. HeartRhythm Case Reports 2016 2, 159-163DOI: (10.1016/j.hrcr.2015.12.008) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 2 Magnetic resonance imaging–based segmentation. A: Anteroposterior (AP) view of internal organs. B: Left lateral view. C: Posteroanterior (PA) view with a superior tilt. D: Left anterior oblique (LAO) view with a superior tilt. IJV = internal jugular vein; IVC = inferior vena cava; LV = left ventricle; PVA = pulmonary venous atrium; PVP = pulmonary venous pathway; RV = right ventricle; SVA = systemic venous atrium; SVC = superior vena cava; SVP = systemic venous pathway. HeartRhythm Case Reports 2016 2, 159-163DOI: (10.1016/j.hrcr.2015.12.008) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 3 Intracardiac access and reconstruction. A: Magnetic resonance imaging slice depicting the superior vena cava (SVC) in direct continuity with the systemic venous pathway (SVP) and the systemic venous atrium (SVA). B: Image shows on the left-hand side the systemic venous structures made of the SVC, SVP, and SVA, and on the right-hand side the pulmonary venous atrium (PVA), reconstructed using a 3-dimensional electroanatomic system. C: Anteroposterior radiograph view after the transbaffle puncture with the SL0 guiding sheath within the PVA and the radiofrequency guidewire (arrows) advanced across the left ventricle into the aorta. D: Termination of the atrial flutter after several seconds of radiofrequency application on the septal and basal interatrial septum of the PVA, as shown by the red dots in panel B. CS = coronary sinus; IJV = internal jugular vein; TEE = transesophageal probe. HeartRhythm Case Reports 2016 2, 159-163DOI: (10.1016/j.hrcr.2015.12.008) Copyright © 2016 Heart Rhythm Society Terms and Conditions