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Open Access Case report

Trans-subclavian approach for radiofrequency ablation of premature ventricular contractions originating from subtricuspid annulus: a case report

Teng Li12, Xian-zhang Zhan1, Ping-zhen Yang1, Yu-mei Xue1, Xian-hong Fang1, Hong-tao Liao1 and Shu-lin Wu1*

Author Affiliations

1 Cardiovascular Department, Guangdong Cardiovascular Institute, Guangdong General Hospital, No. 96, Dongchuan Road, Guangzhou 510080, China

2 Department of Cardiology, Affiliated hospital of Guangdong Medical College, No. 57, Renming Road, Zhanjiang 524001, China

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BMC Cardiovascular Disorders 2013, 13:7  doi:10.1186/1471-2261-13-7

Published: 18 February 2013

Abstract

Background

Catheter ablation has been established as a curative treatment strategy for ventricular arrhythmias. The standard procedure of most ventricular arrhythmias originating from the right ventricle is performed via the femoral vein. However, a femoral vein access may not achieve a successful ablation in some patients.

Case presentation

We reported a case of a 29-year old patient with symptomatic premature ventricular contractions was referred for catheter ablation. Radiofrequency energy application at the earliest endocardial ventricular activation site via the right femoral vein could not eliminate the premature ventricular contractions. Epicardial mapping could not obtain an earlier ventricular activation when compared to the endocardial mapping, and at the earliest epicardial site could not provide an identical pace mapping. Finally, we redeployed the ablation catheter via the right subclavian vein by a long sheath. During mapping of the subvalvular area of the right ventricle, a site with a good pace mapping and early ventricular activation was found, and premature ventricular contractions were eliminated successfully.

Conclusion

Ventricular arrhythmias originating from the subtricuspid annulus may be successfully abolished via a trans-subclavian approach and a long sheath. Although access via the right subclavian vein for mapping and ablation is an effective alternative, it is not a routine approach.

Keywords:
Premature ventricular contractions; Tricuspid annulus; Radiofrequency catheter ablation