Successful Catheter Ablation of a Right-Sided Accessory Pathway in a Child With Interruption of the Inferior Vena Cava and Azygos Continuation

Abstract

SUMMARYAzygos continuation is seen in 0.6% of patients with congenital heart disease. The major significance of this anomaly lies in its association with complex cardiac defects and the technical difficulty that can accompany cardiac catheterization. We report our experience with successful catheter ablation of a right posteroseptal concealed accessory pathway in a 6-year-old boy with infrahepatic interruption of the inferior vena cava and azygos continuation. (Int Heart J 2005; 46: 537-541) Key words: Azygos continuation, Accessory pathway, Ablation USE of radiofrequency catheter ablation (RFCA) in the treatment of supraventricular tachycardias (SVT), as well as its success and complication rates, is influenced by the presence of congenital anomalies. We wish to share our experience with successful catheter ablation of a right posteroseptal concealed accessory pathway (AP) in a 6-year-old boy with infrahepatic interruption of the inferior vena cava (IVC) and azygos continuation. To the best of our knowledge, catheter ablation has not yet been reported in this anomaly. CASE REPORTA 6-year-old boy was admitted because of palpitations and dizziness. His history revealed that the palpitations had started two years earlier, recurred 2-3 times a year, lasted 1-3 hours, and started and ended abruptly.His body weight and height were 21 kg and 115 cm (50 th centile for both), respectively. A physical examination was normal. A 12-lead surface ECG showed sinus rhythm, with no signs of abnormal conduction or impulse generaFrom the

Implantation of ileofemoral stents: A novel approach for bilateral occlusions of the iliofemoral vein in a patient with a Glenn operation

“…The superior approach via the jugular vein or azygos vein is an effective method for an IVC deficiency and occluded iliofemoral veins. Thus far the successful ablation of atrioventricular reentry tachycardia, atrioventricular nodal reentry tachycardia, and AFL have been reported by a superior approach 4, 5, 6, 7. However, catheter manipulation can be quite difficult because the catheter has to pass multiple vessels and cardiac chambers.…”

Percutaneous Transhepatic Venous Access for Catheter Ablation Procedures in Patients With Interruption of the Inferior Vena Cava

“…A superior approach through the SVC has been well described for invasive electrophysiology procedures, including atrial flutter and fibrillation procedures. [1][2][3][4][5][6][7][8][9] However, this approach may be suboptimal for both of the procedures described herein. Variation in respiration may prevent optimal tissue-catheter contract during RA isthmus ablation.…”

“…In these rare situations, access to the heart may still be achieved with a superior approach, that is, with catheters descending from the superior vena cava (SVC) into the right side of the heart. [1][2][3][4][5][6][7][8][9] Alternatively, left-sided heart arrhythmias may be accessed using a retrograde aortic approach. 10 However, these approaches are less favorable due to diminished catheter control and stability.…”

Noncontact Mapping Guided Ablation of Right Ventricular Outflow Tract Ectopy in a Patient with Interruption of the Inferior Vena Cava and Azygos Continuation

“…There have been some reports of successful radiofrequency catheter ablation for supraventricular arrhythmias such as atrioventricular nodal reentrant tachycardia, 3 atrioventricular reentrant tachycardia, or typical flutter in patients with systemic venous abnormalities. 4,5 The most common access to the heart is the lower approach, via the femoral veins, but also the upper approach, via the jugular or subclavian veins, as used in this case to improve the ablation catheter manipulation has been described. 6 To our knowledge, catheter ablation for RVOT unifocal ectopy has not been reported in a patient with an anomalous IVC with azygos continuation.…”