Case Reports I
AbstractIntroduction Congenital absence of the hepatic segment of the inferior vena cava (IVC) is a well-recognized anatomical variant. Methods A 27-year-old female patient complained of palpitations for 7 years. The ambulatory electrocardiogram depicted 35 126 monomorphic PVCs per day and the surface ECG suggested a RVOT origin. She was found to have metoprolol and propafenone refractory and referred to RFCA. During the procedure, attempts to advance a conventional non-steerable EP catheter and a deflectable ablation catheter to the heart were failed. Angiography revealed an interruption of the IVC and a large azygos vein continuation. However, a single 7Fr magnetic mapping and ablation catheter was remote steered into the heart easily. A regional activation remapping showed that the earliest endocardial activation point, −15 ms, was located in the anterior–lateral region just below the pulmonary valve and perfect pace mapping. Results One RF application at this point eliminated the clinical PVCs without complication. The overall procedure time was 243 min and the total fluoroscopy exposure amounted to a total of 441 s, while fluoroscopy exposure time for remote mapping and ablation was 91 s. During the follow-up of 6 months, there was no symptom and an ambulatory electrocardiogram showed six PVCs per 24 h. Conclusions This is the first report of remote-controlled ablation of RVOT–PVCs in the presence of azygos continuation to the inferior vena cava using the MNS with its soft mapping catheter in conjunction with the integrated electroanatomical mapping system.