Result and technique consideration of radiofrequency catheter ablation of tachycardia in patients with dextrocardia

Intracardiac Echocardiography and Ablation of Atrial Fibrillation in Dextrocardia

BACKGROUND

Dextrocardia with atrial fibrillation (AF) complicates radiofrequency ablation treatment.

METHODS

A case of successful AF ablation in dextrocardia, guided by intracardiac echocardiography (ICE) and the Carto 3 high-density mapping system, is reported.

RESULTS

ICE-guided transseptal puncture and three-dimensional mapping facilitated successful pulmonary vein isolation (PVI). The patient had a good recovery with no recurrence.

CONCLUSION

ICE and Carto 3 system's high-density mapping aid in ablation for abnormal cardiac anatomy, reducing surgical complications.

Therapy of Patients with Cardiac Malposition

Positional abnormalities per se do not require treatment, but in their place, the accompanying pulmonary pathology in dextroposition patients and pathophysiologic hemodynamic abnormalities resulting from multiple defects in patients with cardiac malposition should be the focus of treatment. At the time of the first presentation, treating the pathophysiologic aberrations caused by the defect complex, whether it is by improving the pulmonary blood flow or restricting it, is the first step. Some patients with simpler or single defects are amenable to surgical or transcatheter therapy and should be treated accordingly. Other associated defects should also be treated appropriately. Biventricular or univentricular repair dependent on the patient's cardiac structure should be planned. Complications in-between Fontan stages and after conclusion of Fontan surgery may occur and should be promptly diagnosed and addressed accordingly. Several other cardiac abnormalities unrelated to the initially identified heart defects may manifest in adulthood, and they should also be treated.

Successful radiofrequency catheter ablation of Wolff-Parkinson-White syndrome in a patient with dextrocardia: A case report

Background

Dextrocardia is a congenital heart malformation with a low incidence that occurs in only 1 in 10,000–12,000 people. Wolff-Parkinson-White (WPW) syndrome is a congenital condition with additional accessory pathways between the atria and the ventricle, which affects up to three in 1,000 people worldwide. Experience of radiofrequency catheter ablation in patients with WPW syndrome and dextrocardia is scarce due to its rare incidence.

Case presentation

A 39-year-old female was hospitalized due to two episodes of palpitations in the latest 2 months. The morphology of the P-QRS-T complex of lead aVR and aVL, II, and III were presented invertedly as common conditions, and shortened P-R interval and a characteristic “delta” wave were shown on the electrocardiogram (EGM). The patient with dextrocardia and situs invertus malposition was confirmed by chest-X ray, cardiac color Doppler echocardiography. The patient was diagnosed with WPW syndrome with dextrocardia and underwent radiofrequency catheter ablation (RFCA) successfully. In this case, the key to the success of RFCA is to understand the anatomical structure of the heart and the great vessels before the operation and make a personalized operative plan.

Conclusion

Catheter ablation for tachycardia patients with dextrocardia is efficient and safe. For patients with dextrocardia, the key to successful ablation was adjusting for projection angulation and different catheter manipulation compared with a standard case because of the mirror image of a normal heart.