Case 3
A 15-year-old boy with a history of Rastelli procedure using a Hancock
valve conduit for congenitally corrected transposition of great
arteries, ventricular septal defect and pulmonary atresia underwent
ablation for the complaint of palpitations for the last 6 months. The
EnSite™ NavX Precision system (St. Jude Medical St. Paul, MN, USA) is
used as three dimensional mapping system and TacticathTM Quartz Contact Force (St. Jude Medical St. Paul,
MN, USA) with Agilis™ NxT Steerable Introducer for mapping and ablation
procedure. Selective coronary angiography was performed as catheter
could not be positioned into the coronary sinus despite multiple
attempts which revealed that coronary veins were opened separately
without confluence of the coronary sinus. The Duodecapolar Steerable
catheter (Medtronic, USA) was placed in the right atrium. Since the
stable atrium potential could not be obtained, the transesophageal
electrode (Esolo FIAB, Italy) was advanced into the esophagus towards
the left atrium neighborhood via the nasal route. The tachycardia with
1:1 VA relationship was induced by single extra stimulus and catheter
manipulation in the patient. Tachycardia was interrupted with
entrainment mapping, and tachycardia was terminated by administration of
adenosine. Activation and voltage mapping were performed during
tachycardia in order to evaluate the scar areas in the atrium (figure
2a). Diagnostic maneuvers revealed AVRT with earliest atrial activity
during tachycardia localized left posteroseptal region. Catheter was
advanced into left atrium via patent foramen ovale, and then early
atrial activity of the left atrium was mapped during tachycardia, -35 ms
atrial activation was obtained in the left posterior region. Ablation
was performed successfully without any complications.