Successful radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia in a patient with dextrocardia due to unilateral pulmonary agenesis: a case report

Figures & data

Figure 1 Twelve-lead rest electrocardiogram showing positive QRS complexes (with upright P and T waves) in aVR, inversion of all complexes in lead I, and absent R wave progression in the chest leads (dominant S waves throughout).

Figure 2 Twelve-lead electrocardiogram showing supraventricular tachycardia with a regular, narrow QRS tachycardia at a rate of 170 bpm, during which the P wave was indiscernible, in a patient with dextroposition of the heart.

Figure 3 A lung window setting computed tomography scan.

Notes: The scan reveals nearly a complete absence of the right lung and the absent right pulmonary artery (arrow). The space around the atretic pulmonary artery is filled with fibro-fatty tissue with collaterals. The heart and mediastinum are shifted toward the right side.
Abbreviations: LA, left atrium; LV, left ventricle; RV, right ventricle.

Figure 4 Fluoroscopic view in the 15° anteroposterior projection after contrast injection.

Abbreviations: IVC, inferior vena cava; RA, right atrium; RV, right ventricle.

Figure 5 Intracardiac recording.

Notes: (A) Three surface electrocardiographic leads and intracardiac electrograms are shown at a paper speed of 100 mm/s. Premature atrial stimulation at a coupling interval of 310 ms during a basic pacing cycle length of 600 ms initiated the typical form of atrioventricular nodal reentrant tachycardia. VA interval is 45 ms. (B) Slow pathway electrogram is shown in intracardiac electrogram (arrow).
Abbreviations: A, atrial intracardiac electrogram; abl d, distal ablation electrode; abl p, proximal ablation electrode; hra d, high right atrium distal; hra p, high right atrium proximal; V, ventricular intracardiac electrogram.

Figure 6 Fluoroscopic image with a modified anteroposterior projection showing an ablation catheter at the region of the slow pathway (Abl) and a quadripolar diagnostic catheter on the His bundle position (D).

Figure 7 Fluoroscopic image with a modified anteroposterior projection showing an ablation catheter at the region of the coronary sinus ostium (CS os) and a quadripolar diagnostic catheter on the right ventricular outflow tract (RVOT).

Figure 8 Intracardiac electrogram of junctional rhythm after radiofrequency ablation of the slow pathway.

Abbreviations: A, atrial intracardiac electrogram; abl d, distal ablation electrode; abl p, proximal ablation electrode; hra d, high right atrium distal; hra p, high right atrium proximal; V, ventricular intracardiac electrogram.