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Slow pathway ablation for atrioventricular nodal reentry using a right internal jugular vein approach: a case series
Yasser S Salem1, Marin C Burke, Susan S Kim
1Division of Cardiology, Department of Internal Medicine, University of Chicago, Chicago, Illinois, USA.
Insights
A superior vena cava (SVC) approach via the right internal jugular vein enables successful ablation of slow pathway for atrioventricular nodal reentrant tachycardia in patients with inferior vena cava (IVC) obstruction. This method provides a safe alternative when standard IVC access is not possible.
Area of Science:
- Cardiology
- Electrophysiology
- Vascular Access
Background:
- Inferior vena cava (IVC) obstruction prevents standard venous access to the right heart for electrophysiology procedures.
- Existing IVC filters can impede transvenous catheter placement.
- Alternative access routes are crucial for patients with venous barriers.
Observation:
- A case series of three patients with IVC filters successfully underwent ablation for typical atrioventricular (AV) nodal reentrant tachycardia.
- Procedures utilized a superior vena cava (SVC) approach through the right internal jugular (IJ) vein.
- Dual sheath placement in the IJ vein facilitated catheter manipulation and monitoring.
Findings:
- Catheter ablation of the slow AV nodal pathway was technically successful in all three patients.
- Radiofrequency applications ranged from 7 to 27.
- No procedural complications or tachycardia recurrence were observed during follow-up.
Implications:
- The SVC approach via the right IJ vein is a viable and safe alternative for cardiac ablation in patients with IVC obstruction.
- This technique expands treatment options for complex tachycardia management.
- Successful outcomes suggest broader applicability in similar challenging cases.
Background:
Inferior venous access to the right heart is not possible in some patients due to congenital or acquired obstruction of the inferior vena cava (IVC). Although right-sided electrophysiology procedures have been performed successfully in patients with a previously placed IVC filter by direct placement of catheters through the filter, an alternative approach is necessary in some patients.
Methods:
This case series describes three patients with an IVC filter who underwent successful ablation of the slow pathway for typical atrioventricular (AV) nodal reentrant tachycardia using a superior vena cava (SVC) approach via the right internal jugular (IJ) vein. Two separate introducer sheaths were placed into the IJ vein using separate punctures. This permitted placement of a standard deflectable ablation catheter and an additional catheter in the right atrium to monitor for ventriculoatrial conduction during the junctional rhythm associated with ablation of the slow AV nodal pathway.
Results:
Catheter ablation was successful in each patient. The number of radiofrequency current applications was 7, 17, and 27. There were no procedural complications and no patient had recurrent tachycardia during follow-up.
Conclusions:
Catheter ablation of the slow AV nodal pathway can be performed successfully and safely in patients with inferior venous barriers to the right heart using an SVC approach via the right IJ vein.
