A 49-year-old man with symptomatic atrial tachycardia refractory to antiarrhythmic treatment.
Electrophysiological study showed left atrial flutter and persistent left superior vena cava association, draining to the right atrium through the coronary sinus and absence of right superior vena cava.
The possibility of trying to fulgurrate his arrhythmia with a non-negligible rate of failure and recurrence was discussed with the patient, versus a form of definitive symptomatic implant through ventricular fibrillation-ventricular fibrillation.
The implant was placed through puncture of the left axillary vein, advancing the electrode Saint Jude® model 1488T through the left superior vena cava and coronary sinus, to the right atrium.
The electrode was advanced at the level of the right ventricular outflow tract and finally positioned at the apex of the ventricle, where a sensitive R wave of 14.0 mV stimulation was obtained with a 0.5 Oh50 Volt.
Location of the atrioventricular node was performed.
There were no complications and the patient was discharged the following day.
Subsequent controls showed normal parameters at one year and 10 months of follow-up, with total relief of symptoms without antiarrhythmic treatment.
