Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2019 Feb;98(6):e14320.
doi: 10.1097/MD.0000000000014320.

Atrioventricular reentrant tachycardia in a child with tricuspid atresia: A case report of catheter ablation

Yefeng Wang  1 , Qiming Liu  2 , Xicheng Deng  3 , Yunbin Xiao  1 , Zhi Chen  1
Affiliations
Case Reports

Atrioventricular reentrant tachycardia in a child with tricuspid atresia: A case report of catheter ablation

Yefeng Wang et al. Medicine (Baltimore). 2019 Feb.

Abstract

Rationale: Atrioventricular reentrant tachycardia (AVRT) is the most common supraventricular tachycardia occurring in children. However, in complex congenital heart disease patients with a different heart anatomy and conduction system morphology, accessory pathway modification may be particularly challenging because of distortion of typical anatomic landmarks.

Patient concerns: A 10-year-old boy with tricuspid atresia and history of bidirectional Glenn operation had recurrent chest distress and palpitation for 3 months. He had multiple hospitalizations for narrow-QRS tachycardia with poor hemodynamic tolerance, despite the use of adenosine and amiodarone.

Diagnoses: AVRT. Tricuspid atresia with secundum atrial septal defect, large ventricular septal defect, and right ventricular outflow tract stenosis.

Interventions: Cardiac catheterization, electrophysiological examination, and ablation.

Outcomes: The child has not had a recurrent AVRT during 6 months of follow-up and is waiting for Fontan operation.

Lessons: Since there is an increased risk of accessory pathways in patients with tricuspid atresia, all these patients should be checked before the Fontan operation to exclude congenital accessory pathways.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Angiocardiography showed anatomy of the heart in anteroposterior views. A, Power contrast injection via a 5-French pigtail catheter in the right atrium (RA) showed the absence of a right-sided AV valve, a secundum atrial septal defect, and a patent left-sided AV valve with left ventricular (LV) filling. B, A 5-French pigtail catheter was located in right ventricular (RV) through the ventricular septal defect. Angiography showed severe stenosis in right ventricular outflow tract. LA = left atrium, MPA = main pulmonary artery.
Figure 2
Figure 2
A, Electrocardiogram of clinical tachycardia with a cycle length of 389 ms. B, The site of earliest atrial activation was localized in the coronary sinus, which was recorded by the ablation catheter, between electrodes 1-2 and 3-4.
Figure 3
Figure 3
Location of the His-bundle electrogram and site of ablation. A, Electroanatomic maps of right atrial during tachycardia. Red circles and the catheter tip indicate the location of ablation lesions (ABL). White circles represent sites where His-bundle electrograms were recorded (HIS). B, Site of ablation, in the coronary sinus (CS) between CS1-2 and CS3-4 in left anterior oblique view.
See this image and copyright information in PMC

References

    1. Philip Saul J, Kanter RJ, Abrams D, et al. PACES/HRS expert consensus statement on the use of catheter ablation in children and patients with congenital heart disease: developed in partnership with the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS). Endorsed by the governing bodies of PACES, HRS, the American Academy of Pediatrics (AAP), the American Heart Association (AHA), and the Association for European Pediatric and Congenital Cardiology (AEPC). Heart Rhythm 2016;13:e251–89. - PubMed
    1. Brugada J, Blom N, Sarquella-Brugada G, et al. Pharmacological and non-pharmacological therapy for arrhythmias in the pediatric population: EHRA and AEPC-Arrhythmia Working Group joint consensus statement. Europace 2013;15:1337–82. - PubMed
    1. Khairy P, Seslar SP, Triedman JK, et al. Ablation of atrioventricular nodal reentrant tachycardia in tricuspid atresia. J Cardiovasc Electrophysiol 2004;15:719–22. - PubMed
    1. Arana-Rueda E, Pedrote A, Sánchez-Brotons JA, et al. Ablation of atrioventricular nodal reentrant tachycardia in a patient with tricuspid atresia guided by electroanatomic mapping. Pacing Clin Electrophysiol 2012;35:e293–5. - PubMed
    1. Weipert J, Noebauer C, Schreiber C, et al. Occurrence and management of atrial arrhythmia after long-term Fontan circulation. J Thorac Cardiovasc Surg 2004;127:457–64. - PubMed

Publication types

MeSH terms