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RUMAH SAKIT JANTUNG & PEMBULUH DARAH HARAPAN KITA

Instalasi Diagnostik Invasif & Intervensi Non Bedah
JAKARTA 11420

AVRT ABLATION REPORT

Patient Name Imas Masriah, Mrs Age 46 years old Sex M
MR No 2018453795 Insurance Coverage JKN
Case No 4517-0719-I-ABL Date 29-07-2019
Hospital PJN Harapan Kita Jakarta

Clinical Diagnosis SVT (Suspected AVRT)

Procedure :
1. Previous ECG showed sinus rhythm with episode of SVT with long RP interval.
2. Right inguinal- and right internal jugular areas were prepared and draped.
3. One uncomplicated right internal jugular and three right femoral vein punctures were done. Four 6F and 7F-6F-
6F sheaths were inserted, respectively.
4. Two quadripolar electrode catheters were inserted and placed in HIS and right ventricle (RV) apex. One 7F 4mm
non-irrigating ablation catheter was inserted and placed at the HRA. One decapolar catheter was inserted into
the CS.
5. Narrow complex SVT with TCL of 340 ms was easily induced by catheter manoeuvre.
6. CS tracing showed the most fused A-V being at the CS1-2, corresponding with left lateral position.
7. One femoral artery puncture with 7F sheath was inserted. Ablation catheter was advanced to LV retrogradely
through aorta.
8. IV Heparin 5000u given intravenously.
9. RVOP with PCL of 300 ms required >1 beat to follow. The response was VAV with PPI-TCL <115 ms. VA interval
152 ms. HSVPB showed no reset. Therefore, the diagnosis was orthodromic AVRT with left lateral AP.
10. Electrophysiology study was conducted. Basic Interval measurement : P-P 677 ms, AH 62 ms, HV 35 ms, PR 135
ms, QRS 102 ms, QT 322 ms, RR 677 ms, QTc 391 ms.
11. Ventricle pacing showed RV ERP 210 ms, retrograde WP 240 ms with retrograde AP ERP 260 ms.
12. Re-mapping with ablation catheter found the most fused AV with the earliest A (during ventricular pacing) at
CS5-6, which was a posterolateral position.
13. Multiple RFAs (20-30w, 600C, 60-120s) failed to terminate the retrograde AP conduction. Catheter instability was
suspected. An antegrade approach was decided.
14. After transseptal puncture using SLO long sheath and BRK needle was done, ablation catheter was advanced and
directed to CS5-6. Multiple RFAs (20-30w, 600C, 60-120s) successfully terminated the retrograde AP conduction.
15. Incremental pacing from RA showed antegrade WP 290 ms.
16. Programmed atrial stimulation showed A ERP 260 ms, antegrade AVN ERP <270 ms.
17. Measurement of sinus node function were as followed:
PCL BCL SNRT CSNRT
600 920 1090 170
500 920 1200 280
400 1050 1250 200
350 970 1170 200

18. Observation for 20 minutes showed persistent retrograde block.

19. Procedure was concluded without complication. DAP 99206 mGycm², fluoro time 81:34 min. Total contrast 15cc
Iopamiro 370.

Conclusions :
1. Orthodromic AVRT with Left Posterolateral Accessory Pathway
2. Successful Ablation of Left Posterolateral Accessory Pathway
3. Normal SA and AV node function

Attending Physician dr. Sunu Budi Raharjo Sp.JP (K), PhD / dr. Dony Yugo SpJP
Fellow dr. Ahmad Suhaimi Sp.JP / dr. M. Muqsith SpJP
Residence dr. Arif Adimulya T