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
. 2025 Aug 22;11(11):1171-1174.
doi: 10.1016/j.hrcr.2025.08.018. eCollection 2025 Nov.

A particularly atypical case of atypical flutter in a patient after a Mustard repair for d-transposition of the great arteries

Amandeep Kaur  1 , Michael Malaty  1 , Amardeep Amardeep  1 , Nicholas Collins  1   2 , Krishnakumar Nair  3 , Nicholas Jackson  1   2
Affiliations
Case Reports

A particularly atypical case of atypical flutter in a patient after a Mustard repair for d-transposition of the great arteries

Amandeep Kaur et al. HeartRhythm Case Rep. .
No abstract available

Keywords: Atypical atrial flutter ablation; Congenital heart disease; Mustard repair; Perimitral flutter; d-Transposition of the great arteries.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
A: Twelve-lead electrocardiogram of the patient’s tachycardia. The ventricular rate is 260 beats/min, suggesting 1:1 atrioventricular conduction at this point. The QRS had a right bundle branch block morphology (130 ms) and a right axis deviation (common in dextro-transposition of the great arteries with a Mustard repair), which was identical to the QRS in sinus rhythm. B: Electrograms from the interrogation of the patient’s implantable cardioverter-defibrillator. These show a regular ventricular rhythm with what appears to be 2:1 conduction to the ventricle. C: An activation map of the systemic and pulmonary venous atria is shown, with the complete cycle length of the tachycardia around the mitral annulus. D: A voltage map of the systemic and pulmonary venous atria is shown, which corresponds to the activation map. Low voltage (<0.05 mV; red) is seen at the inferior vena cava (IVC) baffle and at the medial aspect of the tricuspid valve (TV). Healthy voltage (>0.5 mV) is shown in purple. LAA = left atrial appendage/systemic venous appendage; LIPV = left inferior pulmonary vein; MV = mitral valve; RSPV = right superior pulmonary vein; SVC Baffle = superior vena cava baffle.
Figure 2
Figure 2
A: A fluoroscopy image in the right anterior oblique (RAO) view showing the location of the electrophysiology catheters (labeled) during mapping. The atrial pacing lead is shown in the systemic venous atrial appendage, and an abandoned passive pacing lead and a defibrillation lead are shown in the subpulmonary ventricle. The OctaRay catheter has splines at the ostium of the left inferior pulmonary vein. B: A fluoroscopy image in the RAO view showing the same catheters; however, here the OctaRay catheter can be seen flexed back on itself to map the medial aspect of the pulmonary venous atrium.
Figure 3
Figure 3
A: Five electrocardiogram leads are shown, followed by an ablation catheter at 9 o’clock on the mitral annulus, a DecaNav catheter with the tip in the left atrial appendage, and a catheter labeled right ventricle, which is in the left ventricular apex. Entrainment at 9 o’clock on the mitral annulus with the ablation catheter accelerates tachycardia to the paced cycle length before the resumption of atypical flutter with 2:1 conduction to the ventricle. The PPI − TCL here is 0 ms, confirming that this point is in the circuit. B: Entrainment at 5 o’clock on the mitral annulus with a PPI − TCL of 8 ms is shown, also confirming that this site is in the arrhythmia circuit. C: Slowing of the atrial cycle length is seen with ablation at 9 o’clock on the mitral annulus, and this leads to resumption of 1:1 conduction to the ventricle. D: Ablation dots are shown in maroon from 9 o’clock on the mitral annulus back to low voltage at the inferior vena cava baffle posteriorly. This lesion set terminated the tachycardia, and then bidirectional block across this line was shown. PPI − TCL = post pacing interval minus tachycardia cycle length.
See this image and copyright information in PMC

References

    1. Jackson N., Barlow M., Emami M., Nair K., Collins N. Clinical problem solving: maneuvering around a narrow complex tachycardia in a patient with Mustard repair for transposition of the great arteries. HeartRhythm Case Rep. 2016;2:536–539. - PMC - PubMed
    1. Khairy P., Landzberg M.J., Lambert J., O’Donnell C.P. Long-term outcomes after the atrial switch for surgical correction of transposition: a meta-analysis comparing the Mustard and Senning procedures. Cardiol Young. 2004;14:284–292. - PubMed
    1. Chiriac A., Cheema K.P., Giardi D., et al. Atrial arrhythmia ablation in patients with d-transposition of the great arteries and atrial switch. Circ Arrhythm Electrophysiol. 2022;15 - PubMed
    1. Houck C.A., Teuwen C.P., Bogers A.J., de Groot N.M. Atrial tachyarrhythmias after atrial switch operation for transposition of the great arteries: treating old surgery with new catheters. Heart Rhythm. 2016;13:1731–1738. - PubMed
    1. Kanter R.J., Papagiannis J., Carboni M.P., Ungerleider R.M., Sanders W.E., Wharton J.M. Radiofrequency catheter ablation of supraventricular tachycardia substrates after Mustard and Senning operations for d-transposition of the great arteries. J Am Coll Cardiol. 2000;35:428–441. - PubMed

Publication types

LinkOut - more resources