Catheter Ablation of Paroxysmal Supraventricular Tachycardia in Patient With Persistent Left Superior Vena Cava

Adil Baimbetov, Kanat Ergeshov, Saken Anartayev, Kenzhebek Bizhanov, Sholpan Alpeissova

Background: Most of the patients are asymptomatic and the presence of the persistent left superior vena cava is incidentally found during or after left subclavian vein catheterization. Central venous catheterization is a commonplace practice for many physicians, including surgeons, arrhythmologists, interventional cardiologists, and other physicians, who are involved in the patients management for interventional procedures.

Case Report: A 48 year old woman was admitted to our department for assessment and management of severe tachycardia and possible myocardial infarction following a sudden onset of palpitations. Objectively she was found to have a regular tachycardia with no overt signs of cardiovascular compromise and was recently diagnosed paroxysmal supraventricular tachycardia (SVT). Therefore, the patient was taken to the operating room by the intervention for electrophysiology study (EPS) and catheter ablation. The diagnosis of PLSVC was discovered unexpectedly at the time of the transvenous approach. The tip for the diagnosis was the unusually medial position of the catheterization guide, and the venogram showed the venous traject towards the coronary sinus and drainage into the right atrium. Decapolar diagnostic electrode was positioned as usual into the coronary sinus from the left side and was performed standart EPS. During the EPS was detected atrioventricular nodal reentry tachycardia and have been performed catheter ablation slow pathway of atrioventricular node with a success.

Conclusion: We reported a rare variant of the superior vena cava system anomaly with a persistent left superior vena cava that has been detected after catheterization for EPS and catheter ablation paroxyzmal SVT. Early and adequate diagnosis is necessary for improved treatment with e.g. catheter-based systems. This knowledge may be useful for other medical specialties that require the implant of left sided transvenous subclavian catheters, like in critical care settings, nephrology, onco-hematology, and anesthesiology.