Systemic venous anatomy in congenital heart disease: implications for electrophysiologic testing and catheter ablation.
BACKGROUND
Cardiac arrhythmias are a significant problem in patients with congenital heart disease. Many patients with congenital heart disease have abnormal systemic venous anatomy which can complicate electrophysiologic testing, catheter ablation and pacemaker and defibrillator implantation. We reviewed the systemic venous anatomy in a cohort of patients undergoing electrophysiologic testing and catheter ablation.


RESULTS
We reviewed all electrophysiologic studies performed in patients with adult congenital heart disease (n = 80) at our institution between January 1998 and October 2009. Ten patients (13%) had a congenital systemic venous anomaly. Of these, seven (9%) had a left superior vena cava and four (5%) had infrahepatic interruption of the inferior vena cava (two had both anomalies). One patient's inferior vena cava was connected to a left-sided atrium; she had right atrial isomerism. In four patients (40%), systemic venous abnormalities were discovered at the time of electrophysiologic testing.


CONCLUSIONS
Systemic venous anomalies occur frequently in the congenital heart disease population and may complicate electrophysiologic testing and catheter ablation. Pre-procedural imaging may assist in facilitating a successful procedure.
Royal Prince Alfred Hospital, Sydney, Australia.
Rachael Louise
RL
Cordina
David S
DS
Celermajer
Mark A
MA
McGuire
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017115:Catheter Ablation / Q000379:methods*; D015331:Cohort Studies; D004452:Echocardiography / Q000379:methods; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D008297:Male; D010690:Phlebography / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D054079:Vascular Malformations / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D014682:Vena Cava, Inferior / Q000002:abnormalities* / Q000601:surgery; D014683:Vena Cava, Superior / Q000002:abnormalities* / Q000601:surgery; D055815:Young Adult