Radiofrequency ablation of post-incisional atrial flutter and high-output heart failure in a patient with interrupted inferior Vena Cava and hereditary hemorrhagic telangiectasia

Srikanth Seethala, Hemal Shah, Friedrich D Knollmann, Ravi Ramani, Jan Němec

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

A 61-year-old female with a history of secundum atrial septal defect repair and hereditary hemorrhagic telan-giectasia presented with epistaxis. She was found to have atypical atrial flutter with 2:1 atrioventricular conduction. Radiofrequency ablation was planned, but inferior vena cava interruption precluded right atrial (RA) access. The RA was then accessed through both subclavian veins, and activation mapping revealed a dense atriotomy scar in the posterolateral inferior RA. Wavefront propagation proceeded caudally through an area of slow conduction confined by the atriotomy scar. Atypical atrial flutter terminated during a second radio-frequency application to an isthmus confined by 2 regions of dense scar. The arrhythmia did not recur, although the patient later experienced typical atrial flutter and atrial fibrillation. High-output heart failure due to systemic arteriovenous shunt was confirmed by cardiac catheterization and improved markedly with bevaci-zumab therapy.

Original languageEnglish (US)
Pages (from-to)474-479
Number of pages6
JournalHellenic Journal of Cardiology
Volume54
Issue number6
StatePublished - Nov 2013

Keywords

  • IVC interruption
  • Post-incisional atrial flutter
  • Subclavian vein

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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