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Successful atrioventricular junction ablation in a patient with situs inversus with dextrocardia and complex venous anatomy  Iosif Kelesidis, MD, MSc,

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Presentation on theme: "Successful atrioventricular junction ablation in a patient with situs inversus with dextrocardia and complex venous anatomy  Iosif Kelesidis, MD, MSc,"— Presentation transcript:

1 Successful atrioventricular junction ablation in a patient with situs inversus with dextrocardia and complex venous anatomy  Iosif Kelesidis, MD, MSc, William Chik, MD, Benoit Desjardins, MD, Nimesh Desai, MD, Rupa Bala, MD, David Lin, MD, FHRS  HeartRhythm Case Reports  Volume 2, Issue 2, Pages (March 2016) DOI: /j.hrcr Copyright © 2016 Heart Rhythm Society Terms and Conditions

2 Figure 1. A: Results of the venography performed via a long sheath inserted from the femoral venous access. The venogram suggested an azygous connection to a persistent right superior vena cava (SVC) with communication to the persistent left SVC. B: A second venogram performed through a pigtail catheter inserted into the persistent left SVC confirming a connection to right atrium (RA). HeartRhythm Case Reports 2016 2, DOI: ( /j.hrcr ) Copyright © 2016 Heart Rhythm Society Terms and Conditions

3 Figure 2. Fluoroscopic position of the ablator and signal at the site of successful atrioventricular node junction ablation. A: Left anterior oblique (LAO) view, 40°: Note that in this patient with dextrocardia, the LAO view represents a true right anterior oblique (RAO) view and highlights the anterior location of the RA lead inserted through the persistent right superior vena cava (SVC) system. The right ventricular (RV) lead tip is directed septally toward the bioprosthetic AV (septum located near RV curve). The ablation-catheter tip is oriented parallel to the RV lead tip, toward the septum. B: RAO view, 40°: Similarly, this image represents the true LAO view. Note the RA lead is directed toward the lateral RA wall and the RV lead points toward the atrioventricular node junction, which is located septally. C: Distal His potential intracardiac electrogram on the ablation catheter (ABLd) captured adjacent to the AV junction after deploying a large curve ablation catheter via a long femoral venous sheath. Radiofrequency ablation delivered at this location resulted in junctional beats HeartRhythm Case Reports 2016 2, DOI: ( /j.hrcr ) Copyright © 2016 Heart Rhythm Society Terms and Conditions

4 Figure 3. These results from the postprocedure computed tomography angiography confirm the right-sided superior vena cava (SVC) with leads entering a grossly dilated coronary sinus (CS) due to the persistent left sided SVC with direct drainage into the RA. The azygous vein inserts directly to the right SVC prior to connecting with the CS). HeartRhythm Case Reports 2016 2, DOI: ( /j.hrcr ) Copyright © 2016 Heart Rhythm Society Terms and Conditions

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