Case 2
This was a 48 year old woman experiencing worsening palpitations for 2 months. She was recently diagnosed with bilateral lower leg deep vein thrombosis and on anticoagulation therapy using rivaroxaban. Venography before the EPS showed thrombus with total occlusion at left interval jugular vein with collaterals to azygos vein. Right internal jugular vein was used as vascular access for CS and ablation catheters (Figure 2A). Basic electrophysiology study showed typical slow-fast AVNRT induced by CS S1S1 and RV S1S1 burst pacing. After 3-D mapping (EnSite NavX system) and identification of His region, cryoablation (Freezor Max, Medtronic CryoCath LP, Canada) was applied at the low Koch triangle area. (Figure 2B). After ablation, tachycardia could no longer be induced.‬‬‬‬‬‬‬‬‬‬‬‬