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Atrial tachycardia ablation in a patient with double outlet right ventricle corrected by surgery.

Abstract
The development of surgical and percutaneous techniques for treatment or palliation of congenital heart disease has prolonged survival in these patients and has increased late complications, particularly arrhythmias. Such arrhythmias are more frequently refractory to medical therapy, requiring percutaneous ablation. We present the clinical case of a 14-year-old child with complex congenital heart disease (double outlet right ventricle) who underwent two corrective surgeries (Rastelli operation and subsequent replacement of the homograft in the conduit connecting the right ventricle to the pulmonary artery; ventricular septal defect closure and tricuspid valve repair). After the second surgery the patient presented with wide complex syncopal tachycardia, refractory to medical therapy. Electrophysiologic study (EPS) identified an isthmus-dependent atrial flutter that was successfully treated by radiofrequency (RF) ablation (a linear block was created along the cavo-tricuspid isthmus). Three months later a new episode of tachycardia occurred, but without syncope. The second EPS revealed an atrial tachycardia originating from the lateral wall of the right atrium, which was treated by ablation with focal application of RF energy. Four months after the last EPS the child remains free of arrhythmic symptoms, under no anti-arrhythmic therapy.
AuthorsKatya Reis-Santos, Pedro Adragão, Diogo Cavaco, Isabel Menezes, José Pedro Neves, Miguel Abecassis, Daniel Bonhorst, Queiroz João e Melo, Fernando Maymone Martins, Ricardo Seabra-Gomes
JournalRevista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology (Rev Port Cardiol) Vol. 23 Issue 2 Pg. 163-77 (Feb 2004) ISSN: 0870-2551 [Print] Portugal
PMID15116454 (Publication Type: Case Reports, Journal Article)
Topics
  • Adolescent
  • Catheter Ablation
  • Double Outlet Right Ventricle (surgery)
  • Electrocardiography
  • Humans
  • Male
  • Postoperative Complications (surgery)
  • Tachycardia (physiopathology, surgery)

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