Radiofrequency Catheter Ablation of Atrioventricular Nodal Reentrant Tachycardia in Patient with Interruption of Inferior Vena Cava

Abstract

We present a 72-year-old man with interruption of inferior vena cava (IVC) with azygos continuation, who underwent radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT). We recorded a His bundle electrogram with an electrode catheter positioned in the aortic root. We also introduced an electrode catheter through the right femoral vein, advanced it via an enlarged azygos vein and the superior vena cava and positioned it at the right ventricular apex (RVA). AVNRT was induced by programmed pacing from a coronary sinus catheter introduced through the left subclavian vein. It was successfully ablated with an ablation catheter introduced through the right internal jugular vein. In a patient with interruption of IVC, it is impossible to access the right side of the heart directly via femoral vein and IVC. In this case, however, alternative routes to the His bundle, RVA and ablation site enabled us to perform an electrophysiologic study and a successful catheter ablation.

Keywords

• Arrhythmia
• Azygos vein
• Venous anomaly
• Electrophysiologic study
• Right cardiac catheterization