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Case Reports
. 2023 Jun 29;9(9):659-661.
doi: 10.1016/j.hrcr.2023.06.016. eCollection 2023 Sep.

Confronting an entrenched atrioventricular node: Ablation strategies for an elusive target

Ian Laxina  1 , Spandana Narvaneni  1 , Khalil Kanjwal  1
Affiliations
Case Reports

Confronting an entrenched atrioventricular node: Ablation strategies for an elusive target

Ian Laxina et al. HeartRhythm Case Rep. .
No abstract available

Keywords: AV nodal ablation; Challenging case; Electrophysiology study; High-output His bundle pacing; Left-sided AV nodal ablation; Radiofrequency ablation; Slow pathway ablation.

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Figures

Figure 1
Figure 1
Fluoroscopic imaging demonstrating the patient’s extensive cardiac instrumentation in the setting of known structural heart and conduction system disease. RA = right atrial lead fixated in the right atrial appendage. A1, A2 = Amplatzer atrial septal occluder devices; His = His lead fixated in the His bundle position; MVR = Edwards bioprosthetic mitral valve replacement; TR = Medtronic tricuspid annuloplasty ring.
Figure 2
Figure 2
CARTO (Biosense Webster) 3D map demonstrating the 3 ablation strategies used. First, the area posterior to the His bundle (yellow marker next to “His” label) was ablated, indicated by teal and red markers. Second, the septal area below the noncoronary cusp (NCC) was ablated, indicated by the blue markers. Third, the anatomical slow pathway (SP), located superior and anterior to the coronary sinus os (CS), was ablated, indicated by ablation catheter and the teal marker outlined in white. On the left, the electrogram demonstrates ventricular pacing after the ablation of the slow pathway, further confirming complete heart block. TA = tricuspid annulus.
See this image and copyright information in PMC

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References

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