title: Slow pathway ablation for atrioventricular nodal reentry using a right internal jugular vein approach: a case series.
abstract: BACKGROUND
  Inferior venous access to the right heart is not possible in some patients due to congenital or acquired obstruction of the inferior vena cava (IVC). Although right-sided electrophysiology procedures have been performed successfully in patients with a previously placed IVC filter by direct placement of catheters through the filter, an alternative approach is necessary in some patients.
  
  
  METHODS
  This case series describes three patients with an IVC filter who underwent successful ablation of the slow pathway for typical atrioventricular (AV) nodal reentrant tachycardia using a superior vena cava (SVC) approach via the right internal jugular (IJ) vein. Two separate introducer sheaths were placed into the IJ vein using separate punctures. This permitted placement of a standard deflectable ablation catheter and an additional catheter in the right atrium to monitor for ventriculoatrial conduction during the junctional rhythm associated with ablation of the slow AV nodal pathway.
  
  
  RESULTS
  Catheter ablation was successful in each patient. The number of radiofrequency current applications was 7, 17, and 27. There were no procedural complications and no patient had recurrent tachycardia during follow-up.
  
  
  CONCLUSIONS
  Catheter ablation of the slow AV nodal pathway can be performed successfully and safely in patients with inferior venous barriers to the right heart using an SVC approach via the right IJ vein.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Chicago, Chicago, Illinois, USA.
authors.forename: Yasser S
authors.initials: YS
authors.lastname: Salem
authors.forename: Marin C
authors.initials: MC
authors.lastname: Burke
authors.forename: Susan S
authors.initials: SS
authors.lastname: Kim
authors.forename: Fred
authors.initials: F
authors.lastname: Morady
authors.forename: Bradley P
authors.initials: BP
authors.lastname: Knight
mesh_terms: D017115:Catheter Ablation; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000601:surgery*; D016896:Treatment Outcome; D016306:Vena Cava Filters; D014683:Vena Cava, Superior