Key result
Jugular-access slow-pathway ablation successfully treats AVNRT in inferior vena cava atresia.
Why the study?
A rare anatomical variation with atresia of the inferior vena cava and azygos persistence complicates catheter ablation for AV nodal reentry tachycardia, requiring alternative approaches.
Case Report (n=1)
Highlights the feasibility of jugular access for AVNRT ablation in patients with inferior vena cava atresia and azygos persistence.
Failed RV access during ablation may signal venous anomalies; hypothesis-generating for preprocedural venography protocols in SVT.
A 72-year-old woman was referred to us with typical symptoms of paroxysmal supraventricular tachycardia for electrophysiological diagnostics and catheter ablation. During the first session of catheter ablation, a probing of the right ventricle was not successful. Therefore, an angiography of the central veins was performed. A rare anatomical variation with atresia of the inferior vena cava below the hepatic veins with azygos persistence was detected. The blood of the lower half of the body was drained via the dilated azygos into the superior vena cava; the blood of the liver veins enters into the right atrium directly. By atypical catheter placement over the azygos vein in the right ventricle and coronary sinus, an AV nodal reentry tachycardia (AVNRT) could be confirmed as the mechanism of tachycardia. However, a stable position of the ablation catheter could not be achieved by the femoral approach, so the successful AV node modulation with ablation of the slow pathway was performed via jugular access.
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Haertel et al. (2022) conducted a case report in AV nodal reentry tachycardia (AVNRT) with atresia of the inferior vena cava (n=1). AV node modulation with ablation of the slow pathway via jugular access was evaluated on Successful AV node modulation. Successful AV node modulation with ablation of the slow pathway was achieved via jugular access in a patient with AVNRT and atresia of the inferior vena cava.
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