Beyond the usual challenges, a case of LV summit PVCs ablation in child with ASO for D-TGA

Abstract

Premature ventricular contractions (PVCs) are a common finding in patients with surgically repaired congenital heart defects including transposition of the great arteries (D-TGA). While often asymptomatic, PVCs can sometimes lead to palpitations, dyspnea, and hemodynamic compromise, requiring therapeutic intervention. The arterial switch operation is the preferred treatment for D-TGA, but these patients have a 2% incidence of ventricular arrhythmias and 1% incidence of sudden cardiac death post-operatively. Though radio-frequency ablation is an effective option for treating outflow ventricular arrhythmias, little data is available on its use in the post-arterial switch D-TGA population. This case report describes a successful catheter ablation of frequent PVCs originating from the left ventricular summit region in a 9-year-old child with a history of arterial switch repair for D-TGA and frequent monomorphic PVCs, highlighting the challenges and considerations in managing ventricular arrhythmias in this complex anatomical setting.

Keywords: ASO; Ablation; Elecroanatomical mapping; Premature ventricular complex (PVC); TGA.

Fig. 1

Electrocardiogram (ECG) showed a sinus rhythm with frequent monomorphic PVCs (bigeminy)

Fig. 2

Intracardiac electrocardiogram showing earliest activation during PVC at CS distal (speed 200 mm/sec)

Fig. 3

Intracardiac electrocardiogram (speed 200 mm/sec) showing earliest activation during PVC on ablation catheter at site of ablation

Fig. 4

Three-dimensional (3D) activation mapping of Aortic root and LVOT showing the earliest activation during PVC above left sided aortic cusp opposite to LV summit

Fig. 5

A Angiography of aortic root (LAO fluoroscopic view). B X-ray image of RF ablation catheter at site of ablation (LAO fluoroscopic view)

Fig. 6

Start of ablation with immediate disappearance of PVCs

Fig. 7

ECG post ablation after 30 min (speed 50 mm/sec)