Radiofrequency catheter ablation in a patient with dextrocardia, persistent left superior vena cava, and atrioventricular nodal reentrant tachycardia

Zheng, Zhipeng; Zeng, Zhihuan; Zhou, Yuliang; Li, Chichang; Zhang, Wei

doi:10.1097/md.0000000000022086

Cited by 6 publications

(7 citation statements)

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“…Routine visualization includes echocardiography, cardiac CT, and 3D mapping. For situs solitus and situs inversus without an additional abnormal anatomy, adjusting for projection angulation and catheter manipulation provides an efficient solution to achieve successful catheter ablation 25,26 . For patients with a complicated anatomy, management entails routine visualization and 3D reconstruction to comprehend the distorted cardiac structure and guide the positioning of the catheter which eventually reduces the procedural duration, minimizes risks of complications from the procedure, and facilitates acute success.…”

Section: Discussionmentioning

confidence: 99%

“…For situs solitus and situs inversus without an additional abnormal anatomy, adjusting for projection angulation and catheter manipulation provides an efficient solution to achieve successful catheter ablation. 25,26 For patients with a complicated anatomy, management entails routine visualization and 3D reconstruction to comprehend the distorted cardiac structure and guide the positioning of the catheter which eventually reduces the procedural duration, minimizes risks of complications from the procedure, and facilitates acute success. In our study, the paucity of 3D mapping and 3D reconstruction caused the failure of three cases, one of which was complicated by an acute tamponade arising from penetration into the aorta.…”

Section: Routine Visualization and Three-dimensional Reconstruction I...mentioning

confidence: 99%

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Result and technique consideration of radiofrequency catheter ablation of tachycardia in patients with dextrocardia

Zhang

Sun

Luo

et al. 2022

Pacing Clinical Electrophis

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Background: Patients with tachycardia, in the context of pre-existing dextrocardia, could benefit from catheter ablation. However, anatomical complexities hinder effective conduct of this procedure. We aimed to retrospectively summarize the clinical characteristics and the safety and efficiency, and recommended the technique considerations.Methods: Twenty-one cases from 19 patients with tachycardia and dextrocardia, who underwent catheter ablation between 2009 and 2021, were enrolled. All patients underwent echocardiography and computed tomography (CT) to confirm the anatomical malformations. Transseptal puncture was guided by fluoroscopy or intracardiac echocardiography when left atrial access was necessary and the ablation process was guided by three-dimensional (3D) mapping.Results: Six cases exhibited situs solitus while nine cases exhibited situs inversus. Fourteen cases had atrial fibrillation, seven had atrial flutter, and two had atrioventricular reentrant tachycardia (AVRT); two cases had combined atrial fibrillation and atrial flutter. Acute success was achieved in 18 cases (85.7%, 18/21). The 3D mapping system was not employed in the three cases which failed. During long-term follow-up (20.71 ± 21.86 months), eight cases (72.7%, 8/11) of atrial fibrillation with dextrocardia successfully attained sinus rhythm. None of AVRT cases had recurrence. Half of the atrial flutter cases with dextrocardia, especially those with a history of surgical correction for cardiac malformations, underwent recurrence. One case had cardiac tamponade. Conclusions:Catheter ablation for tachycardia patients with dextrocardia is safe, efficient, and feasible. It is imperative to integrate echocardiography, cardiac computer tomography, and 3D mapping, and apply 3D reconstruction to facilitate the success of catheter ablation.

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Section: Discussionmentioning

confidence: 99%

Section: Routine Visualization and Three-dimensional Reconstruction I...mentioning

confidence: 99%

Result and technique consideration of radiofrequency catheter ablation of tachycardia in patients with dextrocardia

Zhang

Sun

Luo

et al. 2022

Pacing Clinical Electrophis

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“…The key point to a successful ablation in patients with dextrocardia is understanding the heart’s anatomical structure nd the great vessels and identifying a strategy before conducting the operation. Relevant literature reported that the femoral vein is the most common ablation pathway in supraventricular tachycardia patients with dextrocardia when needed to RFCA ( 14 , 15 ). In some cases, the superior vena cava is also the venous access to the heart ( 12 ).…”

Section: Discussionmentioning

confidence: 99%

Successful radiofrequency catheter ablation of Wolff-Parkinson-White syndrome in a patient with dextrocardia: A case report

Zhao

Li²,

Bai³

et al. 2022

Front. Cardiovasc. Med.

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BackgroundDextrocardia is a congenital heart malformation with a low incidence that occurs in only 1 in 10,000–12,000 people. Wolff-Parkinson-White (WPW) syndrome is a congenital condition with additional accessory pathways between the atria and the ventricle, which affects up to three in 1,000 people worldwide. Experience of radiofrequency catheter ablation in patients with WPW syndrome and dextrocardia is scarce due to its rare incidence.Case presentationA 39-year-old female was hospitalized due to two episodes of palpitations in the latest 2 months. The morphology of the P-QRS-T complex of lead aVR and aVL, II, and III were presented invertedly as common conditions, and shortened P-R interval and a characteristic “delta” wave were shown on the electrocardiogram (EGM). The patient with dextrocardia and situs invertus malposition was confirmed by chest-X ray, cardiac color Doppler echocardiography. The patient was diagnosed with WPW syndrome with dextrocardia and underwent radiofrequency catheter ablation (RFCA) successfully. In this case, the key to the success of RFCA is to understand the anatomical structure of the heart and the great vessels before the operation and make a personalized operative plan.ConclusionCatheter ablation for tachycardia patients with dextrocardia is efficient and safe. For patients with dextrocardia, the key to successful ablation was adjusting for projection angulation and different catheter manipulation compared with a standard case because of the mirror image of a normal heart.

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“…Arrhythmias are usually treated with antiarrhythmic medications and patients without adequate control are subjected to catheter ablation procedures (cryoablation or radiofrequency (RF) ablation). The feasibility of catheter ablation procedures for atrial fibrillation/flutter [ 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 ], supraventricular tachycardia [ 101 , 102 , 103 ], including AVRT [ 101 ] and WPW syndrome [ 104 ], was demonstrated. Patients with an interrupted inferior vena cava should undergo the procedure using the jugular venous approach.…”

Section: Management Of Cardiac Malposition Patients During Adulthoodmentioning

confidence: 99%

Therapy of Patients with Cardiac Malposition

Rao

2023

Children

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Positional abnormalities per se do not require treatment, but in their place, the accompanying pulmonary pathology in dextroposition patients and pathophysiologic hemodynamic abnormalities resulting from multiple defects in patients with cardiac malposition should be the focus of treatment. At the time of the first presentation, treating the pathophysiologic aberrations caused by the defect complex, whether it is by improving the pulmonary blood flow or restricting it, is the first step. Some patients with simpler or single defects are amenable to surgical or transcatheter therapy and should be treated accordingly. Other associated defects should also be treated appropriately. Biventricular or univentricular repair dependent on the patient’s cardiac structure should be planned. Complications in-between Fontan stages and after conclusion of Fontan surgery may occur and should be promptly diagnosed and addressed accordingly. Several other cardiac abnormalities unrelated to the initially identified heart defects may manifest in adulthood, and they should also be treated.

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Radiofrequency catheter ablation in a patient with dextrocardia, persistent left superior vena cava, and atrioventricular nodal reentrant tachycardia

Abstract: Supplemental Digital Content is available in the text

Cited by 6 publications

References 9 publications

Result and technique consideration of radiofrequency catheter ablation of tachycardia in patients with dextrocardia

Result and technique consideration of radiofrequency catheter ablation of tachycardia in patients with dextrocardia

Successful radiofrequency catheter ablation of Wolff-Parkinson-White syndrome in a patient with dextrocardia: A case report

Therapy of Patients with Cardiac Malposition

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