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Atrial tachycardia ablation through the sub-pulmonary ventricle in a patient with multiple malformations associated with congenitally corrected transposition of the great arteries and double-sided slow-pathway
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  • Alberto Preda,
  • Alessio Testoni,
  • Matteo Baroni,
  • Patrizio Mazzone,
  • Lorenzo Gigli
Alberto Preda
ASST Grande Ospedale Metropolitano Niguarda De Gasperis Cardio Center

Corresponding Author:[email protected]

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Alessio Testoni
ASST Grande Ospedale Metropolitano Niguarda De Gasperis Cardio Center
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Matteo Baroni
ASST Grande Ospedale Metropolitano Niguarda De Gasperis Cardio Center
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Patrizio Mazzone
ASST Grande Ospedale Metropolitano Niguarda De Gasperis Cardio Center
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Lorenzo Gigli
ASST Grande Ospedale Metropolitano Niguarda De Gasperis Cardio Center
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Abstract

A 46-year-old woman with congenitally corrected transposition of the great arteries (ccTGA) associated to dextrocardia, situs viscerus inversus and left superior vena cava persistence presented with an incessant supraventricular tachycardia. Electrophysiological study was not conclusive in differential diagnosis of atrial tachycardia versus atypical atrioventricular nodal reentrant tachycardia, also due to the unconventional anatomy of the coronary sinus. By a comprehensive mapping of cardiac chambers, a double side slow-pathway was localized in both atrial chambers and subsequently ablated by radiofrequency delivery without tachycardia changes. Aortic root and cusps were devoid of electrical activity. The muscular part of the sub-pulmonary ventricle at the level of interatrial septum showed an earliest activation signal of -90ms and ablation of this site was effective in abolish the tachycardia. This is the first case to report technical concerns of septal atrial tachycardia ablation in cc-TGA associated with multiple anatomical malformations. Moreover, some peculiarities have been reported for the first time including the presence of double side atrio-ventricular nodal slow-pathway and atypical localization of the tachycardia origin into the muscular part of the sub-pulmonary ventricle instead of posterior pulmonary cusp.