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Percutaneous transhepatic venous access for atrial tachyarrhythmia ablation in patients with single ventricle and interrupted inferior vena cava  Richard.

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Presentation on theme: "Percutaneous transhepatic venous access for atrial tachyarrhythmia ablation in patients with single ventricle and interrupted inferior vena cava  Richard."— Presentation transcript:

1 Percutaneous transhepatic venous access for atrial tachyarrhythmia ablation in patients with single ventricle and interrupted inferior vena cava  Richard Soto, MD, Alejandro Jimenez, MD, Fermin Garcia, MD, Luis C. Saenz, MD, Diego A. Rodriguez, MD, FHRS  HeartRhythm Case Reports  Volume 5, Issue 1, Pages (January 2019) DOI: /j.hrcr Copyright © 2018 Heart Rhythm Society Terms and Conditions

2 Figure 1 A: The 12-lead electrocardiogram (ECG) represents a regular usual complex tachycardia obtained in the emergency department. B: The 12-lead ECG in sinus rhythm. HeartRhythm Case Reports 2019 5, 31-35DOI: ( /j.hrcr ) Copyright © 2018 Heart Rhythm Society Terms and Conditions

3 Figure 2 Percutaneous transhepatic venous access. A: Ultrasound-guided visualization of microneedle puncture to reach the middle hepatic vein. B: Access to the right atrium guided by fluoroscopy through a 5F long sheath dilator and the inch wire. C: Once hepatic venous access is obtained, a large 8.5F deflectable sheath is advanced over a guidewire into the right atrium. D: After retrieval of the deflectable sheath, there is ultrasound evidence of an intraparenchymal tract (blue arrow). E: A vascular embolization coil is placed at the parenchymal-tract interface just outside of the vessel lumen, successfully closing the hepatic tract (blue arrow). HeartRhythm Case Reports 2019 5, 31-35DOI: ( /j.hrcr ) Copyright © 2018 Heart Rhythm Society Terms and Conditions

4 Figure 3 Atrial tachycardia ablation guided by a 3-dimensional mapping system. A: Intra-atrial reentrant tachycardia (IART) with a tachycardia cycle length of 330 ms and concealed entrainment from the suprahepatic vein–right atrium (RA) isthmus successfully terminated with linear ablation achieving bidirectional block. B: IART with a tachycardia cycle length of 290 ms and concealed entrainment along the posterolateral RA scar successfully terminated with linear ablation and bidirectional block. C: Focal atrial tachycardia with tachycardia cycle length of 600 ms with earliest centrifugal activation just below the coronary sinus os, successfully eliminated with focal ablation lesions. HeartRhythm Case Reports 2019 5, 31-35DOI: ( /j.hrcr ) Copyright © 2018 Heart Rhythm Society Terms and Conditions

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