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International Journal of Arrhythmia 2011;12(2): 39-40.
Catheter ablation for AV nodal
reentrant tachycardia in absent right and persistent left SVC

서울대학교 의과대학 내과학교실 오 세 일
Seil Oh, MD, PhD, FHRS
Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Korea


   A 65-year-old man was re-evaluated for recurrent narrow QRS tachycardia. Twelve months ago, a cardiac electrophysiological study (EPS) failed to induce tachycardia, but revealed absent right and persistent left superior vena cava (SVC). A cardiac CT scan was obtained for image integration before EPS. The electroanatomical mapping system was used with CartoMerge software (Biosense-Webster, Diamond Bar, CA). The figure shows 3D images reconstructed by image integration software. The reconstructed images clearly prove the absence of right SVC as well as persistent left SVC with markedly dilated coronary sinus (Figure, A-D). Atrioventricular nodal reentrant tachycardia (AVNRT, slow/fast type) was reproducibly induced by programmed electrical stimulation. Catheter ablation was successfully performed at the rim of the coronary sinus ostium just below the His-bundle potential area (Figure, E). After ablation, tachycardia was not inducible.


   Persistent left SVC alone is not uncommon, but a case with absent right and persistent left SVC is a rare congenital anomaly. Koch’s triangle, which is surrounded by the tendon of Todaro and the coronary sinus ostium, is a critical structure in catheter ablation for AVNRT. However, the anatomical structure of this area is severely deformed in this congenital anomaly due to a markedly dilated coronary sinus. Therefore, the anatomical information is important and the ablation procedure is challenging. In the previous reports, successful ablation sites were not usually slow-pathway areas but the rim of the coronary sinus ostium near the atrioventricular node as the present case.1,2 A 3D mapping system can give us more precise anatomical information to help to target the appropriate site. In the present report, we demonstrate usefulness of an electroanatomical mapping system, and provide images with rich anatomical information. A catheter navigation system may facilitate the procedure as well.3


  1. 1. Okishige K, Fisher JD, Goseki Y, Azegami K, Satoh T, Ohira H, Yamashita K, Satake S. Radiofrequency catheter ablation for av nodal reentrant tachycardia associated with persistent left superior vena cava. Pacing Clin Electrophysiol. 1997;20:2213- 2218.
  2. 2. Pitzalis MV, Forleo C, Luzzi G, Anaclerio M, Barletta A, Di Biase M, Rizzon P. Successful ablation of atrioventricular nodal reentry tachycardia in a patient with persistent left superior vena cava. Cardiologia. 1998;43:741-743.
  3. 3. Ernst S, Ouyang F, Linder C, Hertting K, Stahl F, Chun J, Hachiya H, Krumsdorf U, Antz M, Kuck KH. Modulation of the slow pathway in the presence of a persistent left superior caval vein using the novel magnetic navigation system niobe. Europace. 2004;6:10-14.