An atypical journey during a “typical” EP case

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Kim H. Chan, MBBS, PhD, Raymond W. Sy, MBBS, PhD

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Presentation transcript:

An atypical journey during a “typical” EP case Colby Halsey, MD, Rakesh Latchamsetty, MD HeartRhythm Case Reports Volume 2, Issue 2, Pages 193-196 (March 2016) DOI: 10.1016/j.hrcr.2015.10.008 Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 1 A: A 12-lead electrocardiogram showing premature ventricular contraction morphology. B: Fluoroscopy (anteroposterior view) at the level of the cardiac silhouette after hand-injection of contrast with multipolar catheters in the venous system, showing hemiazygos-to-azygos connection, lack of suprahepatic inferior vena cava–to–right atrium (RA) connection, and contrast flow superiorly via azygos vein to the superior vena cava (SVC). Fluoroscopy in C: right anterior oblique (RAO) 30° and D: left anterior oblique (LAO) 34° showing the circuitous course of the multipolar coronary sinus catheter and the 4 mm ablation catheter positioned at the successful ablation site along the mid-right ventricular septum. The successful site identified by E: activation mapping showing the earliest site of activation (*) and F: nearly identical pace mapping. RV = right ventricle. HeartRhythm Case Reports 2016 2, 193-196DOI: (10.1016/j.hrcr.2015.10.008) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 2 A: Cross-sectional computed tomography imaging shows abdominal situs inversus with “left-sided inferior vena cava” (IVC) (hemiazygos vein), left-sided liver, and polysplenia. B: Hemiazygos to azygos vein continuation. C: Azygos vein to superior vena cava (SVC) connection. D: Coronal view showing “left-sided IVC” (hemiazygos) to azygos vein continuation. HeartRhythm Case Reports 2016 2, 193-196DOI: (10.1016/j.hrcr.2015.10.008) Copyright © 2016 Heart Rhythm Society Terms and Conditions