Trans-subclavian approach for radiofrequency ablation of premature ventricular contractions originating from subtricuspid annulus: a case report

BMC Cardiovascular Disorders

Shu-lin Wu¹  Hong-tao Liao¹  Xian-hong Fang¹  Yu-mei Xue¹  Ping-zhen Yang¹  Xian-zhang Zhan¹  Teng Li² 

[1] Cardiovascular Department, Guangdong Cardiovascular Institute, Guangdong General Hospital, No. 96, Dongchuan Road, Guangzhou 510080, China;Department of Cardiology, Affiliated hospital of Guangdong Medical College, No. 57, Renming Road, Zhanjiang 524001, China

关键词: Radiofrequency catheter ablation;    Tricuspid annulus;    Premature ventricular contractions;   

Others  :  857873
DOI  :  10.1186/1471-2261-13-7

 received in 2012-08-21, accepted in 2013-01-30,  发布年份 2013

【 摘 要 】

Background

Catheter ablation has been established as a curative treatment strategy for ventricular arrhythmias. The standard procedure of most ventricular arrhythmias originating from the right ventricle is performed via the femoral vein. However, a femoral vein access may not achieve a successful ablation in some patients.

Case presentation

We reported a case of a 29-year old patient with symptomatic premature ventricular contractions was referred for catheter ablation. Radiofrequency energy application at the earliest endocardial ventricular activation site via the right femoral vein could not eliminate the premature ventricular contractions. Epicardial mapping could not obtain an earlier ventricular activation when compared to the endocardial mapping, and at the earliest epicardial site could not provide an identical pace mapping. Finally, we redeployed the ablation catheter via the right subclavian vein by a long sheath. During mapping of the subvalvular area of the right ventricle, a site with a good pace mapping and early ventricular activation was found, and premature ventricular contractions were eliminated successfully.

Conclusion

Ventricular arrhythmias originating from the subtricuspid annulus may be successfully abolished via a trans-subclavian approach and a long sheath. Although access via the right subclavian vein for mapping and ablation is an effective alternative, it is not a routine approach.

【 授权许可】

   
2013 Li et al.; licensee BioMed Central Ltd.

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【 参考文献 】

• [1]Ito S, Tada H, Naito S, Kurosaki K, Ueda M, Hoshizaki H, Miyamori I, Oshima S, Taniguchi K, Nogami A: Development and validation of an ECG algorithm for identifying the optimal ablation site for idiopathic ventricular outflow tract tachycardia. J Cardiovasc Electrophysiol 2003, 14(12):1280-1286.
• [2]Daoud E, Morady F: Catheter ablation of ventricular tachycardia. Curr Opin Cardiol 1995, 10(1):21-25.
• [3]Coggins DL, Lee RJ, Sweeney J, Chein WW, Van Hare G, Epstein L, Gonzalez R, Griffin JC, Lesh MD, Scheinman MM: Radiofrequency catheter ablation as a cure for idiopathic tachycardia of both left and right ventricular origin. J Am Coll Cardiol 1994, 23(6):1333-1341.
• [4]Klein LS, Shih HT, Hackett FK, Zipes DP, Miles WM: Radiofrequency catheter ablation of ventricular tachycardia in patients without structural heart disease. Circulation 1992, 85(5):1666-1674.
• [5]Yamada T, McElderry HT, Doppalapudi H, Okada T, Murakami Y, Yoshida Y, Yoshida N, Inden Y, Murohara T, Plumb VJ, et al.: Idiopathic ventricular arrhythmias originating from the left ventricular summit: anatomic concepts relevant to ablation. Circ Arrhythm Electrophysiol 2010, 3(6):616-623.
• [6]Baman TS, Ilg KJ, Gupta SK, Good E, Chugh A, Jongnarangsin K, Pelosi FJ, Ebinger M, Crawford T, Oral H, et al.: Mapping and ablation of epicardial idiopathic ventricular arrhythmias from within the coronary venous system. Circ Arrhythm Electrophysiol 2010, 3(3):274-279.
• [7]Tada H, Ito S, Naito S, Kurosaki K, Kubota S, Sugiyasu A, Tsuchiya T, Miyaji K, Yamada M, Kutsumi Y, et al.: Idiopathic ventricular arrhythmia arising from the mitral annulus: a distinct subgroup of idiopathic ventricular arrhythmias. J Am Coll Cardiol 2005, 45(6):877-886.
• [8]Tada H, Tadokoro K, Ito S, Naito S, Hashimoto T, Kaseno K, Miyaji K, Sugiyasu A, Tsuchiya T, Kutsumi Y, et al.: Idiopathic ventricular arrhythmias originating from the tricuspid annulus: prevalence, electrocardiographic characteristics, and results of radiofrequency catheter ablation. Heart Rhythm 2007, 4(1):7-16.
• [9]Yue-Chun L, Wen-Wu Z, Na-Dan Z, Teng Z, Pin-Xiao W, Bei G, Jia L, Kang-Ting J, Jia-Feng L: Idiopathic premature ventricular contractions and ventricular tachycardias originating from the vicinity of tricuspid annulus: Results of radiofrequency catheter ablation in thirty-five patients. BMC Cardiovasc Disord 2012, 12:32. BioMed Central Full Text
• [10]Salem YS, Burke MC, Kim SS, Morady F, Knight BP: Slow pathway ablation for atrioventricular nodal reentry using a right internal jugular vein approach: a case series. Pacing Clin Electrophysiol 2006, 29(1):59-62.
• [11]Lim HE, Pak HN, Tse HF, Lau CP, Hwang C, Kim YH: Catheter ablation of atrial fibrillation via superior approach in patients with interruption of the inferior vena cava. Heart Rhythm 2009, 6(2):174-179.
• [12]Bian C, Ma J, Yao S, Lv X, Wang J: Transjugular approach for radiofrequency ablation of premature ventricular contractions originating from the superior tricuspid annulus. Pacing Clin Electrophysiol 2012, 35(12):e358-e360.