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.