Catheter ablation with transbaffle puncture and high-density mapping successfully terminated macro-reentrant flutter and focal atrial tachycardia, restoring stable sinus rhythm in a Fontan patient.
Case Report (n=1)
No
This case demonstrates the feasibility and safety of catheter ablation in complex Fontan anatomy using preprocedural CT guidance for transbaffle puncture and advanced mapping.
Atrial arrhythmias are frequent and potentially life-threatening late sequelae in adults with Fontan physiology. We present the case of a 36-year-old woman with an intracardiac lateral tunnel Fontan and prior Amplatzer Septal Occluder closure of a residual fenestration, who developed recurrent, drug-refractory supraventricular tachycardia. High-density electroanatomical mapping revealed a macro-reentrant flutter circuit within the conduit, successfully interrupted with linear ablation. Preprocedural cardiac CT guided a transbaffle puncture, performed inferior and right to the occluder, enabling common atrial access. Subsequent mapping identified an additional macro-reentrant flutter and a focal atrial tachycardia, both ablated with restoration of stable sinus rhythm. No arrhythmias were inducible post-procedure. This case underscores the feasibility and safety of catheter ablation in complex Fontan anatomy when guided by meticulous anatomical assessment, tailored access, and advanced mapping technologies.
Maksut et al. (Wed,) conducted a case report in Complex atrial arrhythmia in a Fontan patient (n=1). Catheter ablation with transbaffle puncture and high-density mapping was evaluated on Restoration of stable sinus rhythm and non-inducibility of arrhythmias. Catheter ablation with transbaffle puncture and high-density mapping successfully terminated macro-reentrant flutter and focal atrial tachycardia, restoring stable sinus rhythm in a Fontan patient.