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 language | English (US) |
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Pages (from-to) | 474-479 |
Number of pages | 6 |
Journal | Hellenic Journal of Cardiology |
Volume | 54 |
Issue number | 6 |
State | Published - Nov 2013 |
Keywords
- IVC interruption
- Post-incisional atrial flutter
- Subclavian vein
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine