Atrioventricular nodal reentrant tachycardia and persistent left superior vena cava: A tough nut to crack. Successful ablation with transseptal approach

Catheter ablation via the left atrium for atrioventricular nodal reentrant tachycardia: A narrative review

“…The flow diagram of the literature search, which yielded 30 articles, is presented in Figure 6 . 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 There were 3 cohort studies, 26 , 46 , 51 3 cases series, 24 , 29 , 47 and 24 case reports. These articles described 79 patient experiences.…”

“…These ranged from simple congenital heart disease, such as a patent foramen ovale, to complex congenital heart disease. 23 , 25 , 30 , 32 , 35 , 38 , 42 , 44 , 45 …”

Ablation of atrioventricular-nodal-reentrant-tachycardia in a patient with left-sided superior vena cava and dilated coronary sinus

“…The successful ablation site has been conventionally detected with the use of X-ray fluoroscopy at the area of CS ostium. [ 1 ] A study done with the help of 3D reconstruction and angiography detected more precise location of successful ablation site at 1 cm from CS ostium in the anterior wall. [ 6 ] Slow pathway potential (A:V≅1:4) was detected at conventional site in two out of eight patients, whereas fractionated atrial deflection followed by large ventricular deflection (A:V>1:3) was found in six out of eight patients in the anterior wall of CS, in the study by Liang et al .…”

“…[ 7 ] A left-sided approach targeting the leftward extension of the slow pathway via a transeptal approach may be required in some cases as described by Chokr et al . [ 1 ]…”

“…Atrioventricular-nodal-reentrant-tachycardia (AVNRT) associated with persistent left superior vena cava (PLSVC) and its ablation has been found challenging due to distortion of the triangle of Koch's. [ 1 ] The problems faced in most of these cases were related to catheter stability due to large coronary sinus (CS) ostium (use of transseptal approach[ 1 ] or long sheaths), identification of ideal site for ablation for localizing the slow pathway region (need for multiple sessions of ablation[ 1 2 ] or use of novel 3D reconstruction techniques for mapping[ 2 ]), and risk of AV block due to stability issues with ablation catheter. We highlight the possible difficulties in one such case.…”