Catheter ablation for tachyarrhythmia via superior approach has been used in patients without possible inferior vena cava access such as in cases of venous occlusion or complex anomaly. Difficulty in catheter manipulation, instability, number of required vascular access, and radiation exposure of operator had been described in the procedure. Application of three-dimensional (3-D) mapping system in catheter ablation via superior approach could navigate the guiding catheter and provide more precise ablation. We reported four cases receiving catheter ablation due to atrioventricular nodal reentry tachycardia, atrial fibrillation and right ventricular arrhythmia via superior approach facilitated by 3-D mapping system with fewer vascular access and catheters.
The health crisis due to coronavirus disease 2019 (COVID-19) shocks the world with more than million infections and casualties. COVID-19 could present from mild illness to multi-organ involvement, especially acute respiratory distress syndrome. Cardiac injury and arrhythmias including atrial fibrillation (AF) are not uncommon in COVID-19. COVID-19 is highly contagious, and the therapy against the virus remains premature and largely unknown. These make the management of AF patients during pandemic particularly challenging. We here describe possible pathophysiology link between COVID-19 and AF, and therapeutic considerations for AF patients during this pandemic.