Catheter Ablation -> SVT/AVNRT/WPW/AT: -> Mapping & Imaging D-PO05 - Poster Session V (ID 39) Poster

D-PO05-163 - Shortened Distance From His Bundle To Rightward Inferior Extension: Experience From 10 Atrioventricular Nodal Reentrant Tachycardia Cases With Thoracic Kyphoscoliosis (ID 574)

 F. Yu: Nothing relevant to disclose.


Background: Kyphoscoliosis refers to abnormal curvatures of spine in coronal and sagittal planes, whose variations of heart anatomy may complicate ablation.
Objective: To investigate the specific anatomical and ablation features in atrioventricular nodal reentrant tachycardia (AVNRT) patients with thoracic kyphoscoliosis.
Methods: Retrospectively enrolling patients with thoracic kyphoscoliosis from January 2009 to September 2019 in our center. Radiologically, Cobb angles in scoliosis and kyphosis, heart rotation and His bundle to rightward inferior extension distance were evaluated. All were targeted at rightward inferior extension.
Results: 10 patients (9 slow/fast, 1 slow/slow) were enrolled. Cobb angles in scoliosis were 20.10±20.10° and 36.24±12.25° in kyphosis. Computed tomography revealed a relative large apex to horizon angle (34.25±8.96°, upper left panel),and short distances between the nadir of non-coronary sinuses to the middle of coronary sinus orifices (15.07±7.72mm) in right oblique view, 3/10 cases even less than 1cm (lower panel). The SL1 long sheath was used and ablation titrated from 25 watts, 60℃ in temperature mode. Despite transient complete atrioventricular block in one case, no PR prolongation or loss of VA conduction in junctional reaction was recorded. All ablations had acute success.
Conclusion: There were counterclockwise heart rotations in AVNRT complicated with thoracic kyphoscoliosis. His bundle may be very near to the target of rightward inferior extension and precautions should be taken to avoid atrioventricular block during ablation.