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Palpitations in a 72-year-old woman
  1. Claire A Martin1,
  2. Parag R Gajendragadkar2,
  3. Sharad Agarwal2
  1. 1 Barts Heart Centre, Barts Health NHS Trust, London, UK
  2. 2 Papworth Hospital NHS Foundation Trust, Cambridge, UK
  1. Correspondence to Dr Claire A Martin, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK; clairemartin{at}


Clinical introduction A 72-year-old woman presented with an 8-year history of palpitations occurring every few weeks. They were sudden in onset, were associated with dizziness and could last for up to 2 hours. She was prescribed bisoprolol which reduced the frequency of events but did not abolish them. Baseline ECG and echocardiography were normal. She was referred for electrophysiological study. Despite initial difficulties, diagnostic catheters were placed in the right ventricular (RV) apex and in the coronary sinus (CS) via the right internal jugular vein and superior vena cava (SVC) (figure 1A). A narrow complex tachycardia was easily induced, and ablation was then delivered during tachycardia with the ablation catheter positioned as shown in (figure 1A). This terminated tachycardia 4 s after onset of energy delivery and on follow-up she has remained asymptomatic. She later underwent a CT scan (figure 1B,C; online supplementary video).

Supplementary file 1

Figure 1

(A) Fluoroscopy of catheter placement. (B) Sagittal contrast-enhanced CT image. (C) Axial contrast-enhanced CT.

Question What anatomical abnormality caused difficulty in catheter placement during the procedure?

  1. Azygous continuation of the inferior vena cava (IVC)

  2. Giant Eustachian valve

  3. Dextrocardia

  4. Renal tumour compressing IVC


  • Atrial arrhythmia ablation procedures
  • catheter ablation
  • supraventricular arrhythmias

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  • Contributors CAM, PRG and SA were involved in the clinical case and wrote the manscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.