Abstract
Methods: a 35 yo patient with previous intracardiac total cavopulmonary connection was referred for recurring AT despite antiarrhythmic drugs, after ablation of two right atrial incisional reentry three years ago. Because of surgical closure of the tricuspid valve and lack of fenestration of the conduit, access to the right atrium was only possible by retrograde catheterism through the left ventricle, left atrium then through an atrial septal defect. Results: High density mapping of both right and left atrium was performed during AT using the Orion catheter ™. A common counterclockwise atrial flutter (AF) was diagnosed. Access to the cavo-tricuspid isthmus (CTI) was possible after turning the RF catheter around the intracardiac conduit connecting the inferior vena cava to the pulmonary artery. RF ablation at the CTI (after RF applications in the subhepatic veins and inside the conduit) finally terminated the tachycardia. Conclusion: The Rythmia system™ allows high density mapping and precise activation mapping in post-Fontan univentricular hearts patients. Both atrium may be mapped with the Orion ™ catheter even after complicated retrograde access. Common AF may happen in these patients whose ablation may be difficult due to anatomical constraints.
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