Abstract
[first paragraph of article] Surgical strategy for patients born with a physiological univentricular heart has evolved from atrio-pulmonary (AP) Fontan (right atrium (RA) to pulmonary artery) to its modification, total cavopulmonary connection (TCPC),2 with the goal of reduced post-operative incidence of supraventricular tachycardia (SVT). However, TCPC patients may also present with symptomatic atrial tachycardia, and the sites of origin can be difficult to access due to the surgical strategy. Owing to recent technological advances in the field of electrophysiology, such as electroanatomic mapping (EAM) irrigated-tip catheters9 and remote magnetic navigation (RMN) catheter ablation has become a more relevant and important therapeutic modality for congenital heart disease associated-SVTs. We report on a 33-year-old male, with double inlet left ventricle (DILV) status post TCPC, who underwent catheter ablation of two different atrial tachycardias originating in different parts of the divided RA.
Highlights
Surgical strategy for patients born with a physiological univentricular heart has evolved from atrio-pulmonary (AP) Fontan (right atrium (RA) to pulmonary artery)1 to its modification, total cavopulmonary connection (TCPC),2 with the goal of reduced post-operative incidence of supraventricular tachycardia (SVT).3– 6 TCPC patients may present with symptomatic atrial tachycardia, and the sites of origin can be difficult to access due to the surgical strategy
From the age of 26 years, he had onset of symptomatic arrhythmia leading to multiple DC cardioversions, as well as two ablations at another centre
A simple atrial flutter ablation can turn out to be a major challenge in TCPC patients with a no longer directly accessible RA
Summary
Surgical strategy for patients born with a physiological univentricular heart has evolved from atrio-pulmonary (AP) Fontan (right atrium (RA) to pulmonary artery) to its modification, total cavopulmonary connection (TCPC), with the goal of reduced post-operative incidence of supraventricular tachycardia (SVT). TCPC patients may present with symptomatic atrial tachycardia, and the sites of origin can be difficult to access due to the surgical strategy. Surgical strategy for patients born with a physiological univentricular heart has evolved from atrio-pulmonary (AP) Fontan (right atrium (RA) to pulmonary artery) to its modification, total cavopulmonary connection (TCPC), with the goal of reduced post-operative incidence of supraventricular tachycardia (SVT). . TCPC patients may present with symptomatic atrial tachycardia, and the sites of origin can be difficult to access due to the surgical strategy. Owing to recent technological advances in the field of electrophysiology, such as electroanatomic mapping (EAM), irrigated-tip catheters and remote magnetic navigation (RMN), catheter ablation has become a more relevant and important therapeutic modality for congenital heart disease associated-SVTs. We report on a 33-year-old male, with double inlet left ventricle (DILV) status post TCPC, who underwent catheter ablation of two different atrial tachycardias originating in different parts of the divided RA
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