4. Conclusion
Our case series suggested that it is feasible and safe to perform AVNRT,
VT and AF ablation via superior approach with limited vascular access
and catheters under guidance of 3-D mapping system in patients with
unfavorable femoral vein and IVC anatomy.
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FIGURE LEGEND
FIGURE 1
1A, 1B: Venography showed absence of IVC with azygos and hemiazygos
continuation. * Represented quadripolar catheter in agenesis of IVC.
1C: The electrophysiology tracing suggested slow-fast AVNRT.
1D: The fluoroscopy showed the ablation catheter position over low Koch
area using superior approach via right internal jugular vein and CS
catheter via left femoral approach.
1E: 3-D mapping system created geometry of right atrial and localized
the ablation site.
FIGURE 2
2A: Right internal jugular vein approach with CS and ablation catheter.
2B: Cryoablation at low Koch area with guidance of 3-D mapping system.
Abbreviation the same as Figure 1, LAOleft anterior obliqueRAOright
anterior oblique.
FIGURE 3
3A: Clinical monomorphic sustained VT with LBBB pattern, inferior axis
and QS waves in all precordial leads.
3B: The activation map demonstrated the position of critical isthmus
surrounding the tricuspid annulus and RVOT patch.
3C: Fluoroscopic image of target area between superior tricuspid annulus
and RVOT.
PApulmonary arteryRAright atrium; RVOTright ventricular outflow
tractTAtricuspid annulusVTventricular tachycardia.
FIGURE 4
4A: Reconstructed 3-D geometry of IVC interruption with azygos
continuation.
Coronary sinus catheter was positioned from femoral vein with a SR-0
long sheath.
(Green line) Ablation catheter was advanced through the SL-3 long-sheath
to the LA.
(Yellow line).
4B: Fluoroscopy of transseptal procedure via superior approach.
4C: Voltage mapping after circumferential pulmonary vein isolation.
Table 1. Baseline characteristics and procedure details