Zero-Fluoroscopy Radiofrequency Ablation of a Right Ventricular Outflow Tract PVC in a Patient With Situs Inversus...

Area of Science:

• Adult Cardiac Electrophysiology
• Interventional Cardiology
• Congenital Heart Disease

Background:

• Congenital cardiac anomalies pose significant challenges for electrophysiologists performing complex ablations.
• Situs inversus totalis presents unique anatomical variations requiring specialized procedural approaches.

Purpose of the Study:

• To report a successful zero-fluoroscopy radiofrequency ablation for premature ventricular complexes (PVCs) in a patient with situs inversus totalis.
• To highlight the feasibility and safety of advanced electroanatomic mapping and intracardiac echocardiography in complex congenital heart disease cases.

Main Methods:

• Utilized reversed (mirror-image) precordial lead placement for accurate electrical signal acquisition.
• Employed high-definition 3D electroanatomic mapping for precise anatomical visualization.
• Integrated intracardiac echocardiography to guide the ablation procedure.
• Achieved a completely zero-fluoroscopy approach, minimizing radiation exposure.

Main Results:

• Successful radiofrequency ablation of symptomatic, high-burden PVCs was performed.
• The zero-fluoroscopy strategy was effective and safe, even with significant anatomical variation.
• Demonstrated the utility of advanced mapping and imaging in complex congenital cases.

Conclusions:

• Zero-fluoroscopy PVC radiofrequency ablation is a feasible and safe strategy, even in anatomically challenging conditions like situs inversus.
• Careful anatomical understanding and adapted procedural techniques are crucial for managing patients with congenital cardiac anomalies.
• This case supports the broader applicability of zero-fluoroscopy approaches in complex electrophysiological interventions.