title: Radiofrequency ablation of post-incisional atrial flutter and high-output heart failure in a patient with interrupted inferior vena cava and hereditary hemorrhagic telangiectasia.
abstract: A 61-year-old female with a history of secundum atrial septal defect repair and hereditary hemorrhagic telangiectasia presented with epistaxis. She was found to have atypical atrial flutter with 2:1 atrioventricular conduction. Radiofrequency ablation was planned, but inferior vena cava interruption precluded right atrial (RA) access. The RA was then accessed through both subclavian veins, and activation mapping revealed a dense atriotomy scar in the posterolateral inferior RA. Wavefront propagation proceeded caudally through an area of slow conduction confined by the atriotomy scar. Atypical atrial flutter terminated during a second radiofrequency application to an isthmus confined by 2 regions of dense scar. The arrhythmia did not recur, although the patient later experienced typical atrial flutter and atrial fibrillation. High-output heart failure due to systemic arteriovenous shunt was confirmed by cardiac catheterization and improved markedly with bevacizumab therapy.
authors.affiliation: Department of Internal Medicine, University of Pittsburgh Medical Centers-Mercy Hospital, Pittsburgh, PA, USA.
authors.forename: Srikanth
authors.initials: S
authors.lastname: Seethala
authors.forename: Hemal
authors.initials: H
authors.lastname: Shah
authors.forename: Friedrich
authors.initials: F
authors.lastname: Knollmann
authors.forename: Ravi
authors.initials: R
authors.lastname: Ramani
authors.forename: Jan
authors.initials: J
authors.lastname: Němec
mesh_terms: D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D001282:Atrial Flutter / Q000150:complications / Q000601:surgery*; D000068258:Bevacizumab; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D013683:Telangiectasia, Hereditary Hemorrhagic / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000601:surgery*
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab