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

1 Citation (Scopus)

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

Fingerprint

Hereditary Hemorrhagic Telangiectasia
Atrial Flutter
Inferior Vena Cava
Cicatrix
Heart Failure
Subclavian Vein
Epistaxis
Atrial Heart Septal Defects
Cardiac Catheterization
Radio
Atrial Fibrillation
Cardiac Arrhythmias
Therapeutics

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Radiofrequency ablation of post-incisional atrial flutter and high-output heart failure in a patient with interrupted inferior Vena Cava and hereditary hemorrhagic telangiectasia. / Seethala, Srikanth; Shah, Hemal; Knollmann, Friedrich D; Ramani, Ravi; Němec, Jan.

In: Hellenic Journal of Cardiology, Vol. 54, No. 6, 11.2013, p. 474-479.

Research output: Contribution to journalArticle

@article{8037b5511ff344f3bd90350da4b25027,
title = "Radiofrequency ablation of post-incisional atrial flutter and high-output heart failure in a patient with interrupted inferior Vena Cava and hereditary hemorrhagic telangiectasia",
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.",
keywords = "IVC interruption, Post-incisional atrial flutter, Subclavian vein",
author = "Srikanth Seethala and Hemal Shah and Knollmann, {Friedrich D} and Ravi Ramani and Jan Němec",
year = "2013",
month = "11",
language = "English (US)",
volume = "54",
pages = "474--479",
journal = "Hellenic Journal of Cardiology",
issn = "1109-9666",
publisher = "Hellenic Cardiological Society",
number = "6",

}

TY - JOUR

T1 - Radiofrequency ablation of post-incisional atrial flutter and high-output heart failure in a patient with interrupted inferior Vena Cava and hereditary hemorrhagic telangiectasia

AU - Seethala, Srikanth

AU - Shah, Hemal

AU - Knollmann, Friedrich D

AU - Ramani, Ravi

AU - Němec, Jan

PY - 2013/11

Y1 - 2013/11

N2 - 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.

AB - 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.

KW - IVC interruption

KW - Post-incisional atrial flutter

KW - Subclavian vein

UR - http://www.scopus.com/inward/record.url?scp=84889669289&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84889669289&partnerID=8YFLogxK

M3 - Article

C2 - 24305586

AN - SCOPUS:84889669289

VL - 54

SP - 474

EP - 479

JO - Hellenic Journal of Cardiology

JF - Hellenic Journal of Cardiology

SN - 1109-9666

IS - 6

ER -