Ewha Med J.  2022 Jul;45(3):e6. 10.12771/emj.2022.e6.

Embarrassed Radiofrequency Catheter Ablation of Supraventricular Tachycardia in Pectus Excavatum

• Lee G
• Ban JE

• KMID: 2532212
• DOI: http://doi.org/10.12771/emj.2022.e6

Abstract

A 16-year-old patient with pectus excavatum visited our hospital because of palpitation. He underwent first Nuss operations at the age of 3. When he was 13 years old, the slow-fast type atrioventricular nodal reentrant tachycardia was documented during electrophysiology study. However, the catheter ablation was not conducted because of recurrent atrial fibrillation during procedure. At that time, second Nuss operation was performed due to progressive chest wall deformity. And then, atrioventricular nodal reentrant tachycardia was successfully treated by radiofrequency catheter ablation at the higher position than usual slow pathway zone under the modified fluoroscopic view with the cranial angle although distorted right atrial geometry and radiographic obstacle of Nuss operation bar. The concern about abnormal cardiac and electrical anatomy, and the accurate and modified procedure technique are essential in patients with pectus excavatum. (Ewha Med J 2022;45(3):e6)

Keyword

Tachycardia; Atrioventricular nodal reentry; Catheter ablation; Pectus excavatum; Nuss operation

Figure

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  Fig. 1. 12-lead surface electrocardiogram and Chest X-ray. (A) The baseline surface electrocardiogram showing incomplete right bundle branch block. (B) A wide QRS tachycardia with heart rate of 180 bpm suggesting supraventricular tachycardia with incomplete right bundle branch block pattern. (C) Chest X-ray showing Nuss operation bar (arrows).

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  Fig. 2. Transthoracic echocardiography showing the compression of right atrium on apical four chamber view. RV, right ventricle; LV, left ventricle; RA, right atrium; LA, left atrium.

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  Fig. 3. Successful ablation site of atrioventricular nodal reentrant tachycardia. (A) Intra-cardiac electrogram showing the atrioventricular nodal reentrant tachycardia with earliest atral activation site of His area at a cycle length of 380 ms. (B) Fluoroscopic images in the left anterior oblique (LAO) and right anterior oblique (RAO) projection showing the masablation catheter positioned at the higher site than usual slow pathway zone. RA, right atrium; CS, coronary sinus; ABL, ablation catheter; RV, right ventricular catheter; His, His potential.

Reference

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