RUMAH SAKIT JANTUNG & PEMBULUH DARAH HARAPAN KITA

Instalasi Diagnostik Invasif & Intervensi Non Bedah

JAKARTA 11420

Patient Name Efnita, Mrs Age 60 yo

MR No 2018-44-26-66 Sex Female
Case No 01440119-I_Abl Date 08/01/2019
Reff. Doctor dr. Sunu Budi Raharjo, SpJP(K), PhD Hospital PJNHK

Clinical Diagnosis : Recurrent SVT most likely AVRT, ddx AT

Procedure
1. Pre-prosedure ECG: SR, normal PR interval, no pre-excitation
2. Antiseptic procedure at right femoral and right jugular area.
3. Three uncomplicated right femoral vein puncture were done and one right internal jugular vein puncture was done
done
4. Two quadripolar electrode catheters and one 7F 4mm tip ablation catheter were inserted via 6F sheaths and 7F
sheaths respectively at right femoral vein and placed at RVA, HIS and HRA.
5. One decapolar catheter was inserted via 6F sheath and placed at the CS
6. Basic interval : A-A : 659 P-P : 659 QRS : 115 QTc : 439 V-V : 673 R-R : 673
7. Incremental ventricular pacing showed retrograde conduction with retrograde WP at 420 msec and eccentric atrial
activation and earliest A and the most fused Vand A was at CS 1-2. Suggesting concealed retrograde AP originating
from left lateral wall
8. Programme ventricular stimulation with S1S2 showed AP retrograde ERP at 260 msec and RV ERP at 210 msec
9. Incremental atrial pacing showed antegrade WP at 360 msec
10. Programme atrial stimulation with S1S2 showed antegrade AVN ERP < 260 msec and A ERP 250 msec
11. Sinus node study as followed
PCL BCL SNRT CSNRT
600 680 840 160
500 690 940 250
400 720 1040 320

12. SVT was induced by atrial pacing with Isuprel but unsustainable. Therefore, unable to proceed with the pacing
manoveure during SVT
13. One right femoral artery puncture was done. 8F sheath was inserted and iv heparin 5000u was given
14. Initially, we were attempted to map and able the left lateral AP pathway retrogradely but it was unsuccessful
15. Proceed with transeptal puncture. 7F sheath was changed into 8F long sheath over the terumo wire. Long sheath
was advanced into the Rt SVC. Then, BRK needle was inserted via the long sheath and was placed at the Rt SVC. Long
sheath together with BRK was dragged down under fluoroscopic guidance until dropped at fossa ovalis and
transeptal puncture was done. The long sheath was advanced into the LA guided Inoue wire.
16. 7F 4mm non-irrigated ablation catheter was advanced into mitral annulus, near CS 1-2. Noted fusion V and A.
17. Multiple RFA (55 degree Celsius, 40 watt, for 60-120sec) were delivered to this area during retrograde pacing.
Subsequently V and A separated and retrograde blocked noted during ablation.
18. After 20 minutes observation, pacing from RVA showed retrograde block
19. Procedure was stopped without any complication

Conclusion:
1. AVRT due to concealed left lateral accessory pathway
2. Successful ablation of left lateral accessory pathway
3. Normal SA and AV nodes function

Attending Physician dr. Sunu Budi Raharjo, SpJP(K), PhD

Fellow dr. Hazleena, SpJP/ dr. Muqsith, SpJP
Assistant dr. Dedy/dr. Abdul