Fig-2; In first ECG delta waves was positive in lateral and all
precordial leads, negative polarity in inferior leads in favor of a
left- posterior sided AP
Electrophysiology study was performed. Five introducer-sheaths were
passed over guide wire. Then catheters introduced into the right femoral
vein and right femoral artery. catheters positioned in the high right
atrium, His-recording region, right ventricular apex and CS. Ablation
catheter passed via aorta and positioned in LV.
Mapping of the mitral annulus was performed during ventricular pacing
and sinus rhythm using a 7 French ablation catheter from the right
femoral artery.
Baseline intervals during sinus were as follows: sinus cycle length 800
msec, atrial His (AH) interval 66 msec, and His-ventricular (HV)
interval 10 msec. Programmed atrial and ventricular stimulation were
performed. AVRT was induced with best fused A-V in CS
7,8 . Ablation site was mapped and RF energy was applied at left
posterior region of MV annulus via retrograde approach but not resulted
in VA dissociation. Then trying for septostomy was unsuccessful because
guide wire could not be inserted in SVC. Procedure was terminated
Because of cardiac perforation during try for septostomy.Patient followed by echocardiography and monitoring; no
tamponade observed . After stabilization CT scan of lung and heart was
performed because of a suspicious mass in posterior side of RA during
ablation. Chest CT scan reported PLSVC which drainage to CS, and
diminutive right SVC. TTE also showed LSVC by right- and left-hand
injections (Fig-3).