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).