Raatikainen Pekka, Marjamaa Annukka, Tolppanen Heli, Karvonen Jarkko, Aro Aapo
Department of Cardiology, Heart and Lung Center Helsinki University Hospital, Haartmanninkatu 4, FI-00029 HUS, Helsinki, Finland.
Eur Heart J Case Rep. 2024 Sep 18;8(10):ytae510. doi: 10.1093/ehjcr/ytae510. eCollection 2024 Oct.
Cardiac interventions may be challenging in patients with congenital cardiac abnormalities. This case reports cardiac resynchronization therapy pacemaker (CRT-P) implantation and single catheter ablation of atrioventricular node (AVN) with remote magnetic navigation (RMN) via peripheral vascular access in a patient with Kartagener's syndrome and permanent atrial fibrillation (AF).
A 74-year-old male with situs inversus presented for treatment of permanent AF and severe heart failure. In echocardiography, left ventricular ejection fraction was 30%, and there was severe dyskinesia due to a left bundle branch block. After successful CRT-P implantation, we performed AVN ablation because biventricular (BiV) pacing was <75% despite maximal rate control medication. The ablation catheter was inserted from the right basilic vein, and no other catheters were used. Despite peripheral vascular access, manipulation of the ablation catheter with RMN was easy, and the ablation was successful. After the ablation, BiV pacing instantly increased to 100%, and left ventricular function and symptomatic status improved gradually.
Cardiac resynchronization therapy pacemaker implantation and RMN-guided single catheter ablation of the AVN in a patient with dextrocardia via peripheral vascular access was effective and safe. The use of RMN and peripheral vascular access may offer important advantages also in other patient groups.
对于患有先天性心脏异常的患者，心脏介入治疗可能具有挑战性。本病例报告了在一名患有卡塔格内综合征和永久性心房颤动（AF）的患者中，通过外周血管通路，利用远程磁导航（RMN）植入心脏再同步治疗起搏器（CRT-P）并单导管消融房室结（AVN）的情况。
一名74岁男性，内脏反位，前来治疗永久性AF和严重心力衰竭。超声心动图显示，左心室射血分数为30%，因左束支传导阻滞存在严重运动障碍。成功植入CRT-P后，尽管使用了最大剂量的心率控制药物，双心室（BiV）起搏仍<75%，因此我们进行了AVN消融。消融导管从右贵要静脉插入，未使用其他导管。尽管是外周血管通路，但利用RMN操作消融导管很容易，消融成功。消融后，BiV起搏立即增至100%，左心室功能和症状状态逐渐改善。
通过外周血管通路，在一名右位心患者中植入心脏再同步治疗起搏器并在RMN引导下进行单导管AVN消融是有效且安全的。RMN和外周血管通路的使用在其他患者群体中可能也具有重要优势。
