Case 1
A 25-year-old girl with left atrial isomerism, mitral atresia, moderate
regurgitation of tricuspid valve, non-restrictive ventricular septal
defect, non-restrictive atrial septal defect, severe subpulmonary
stenosis with a systolic gradient of 60 mmHg and both great arteries
were arising from right ventricle presented with high ventricular
responded atrial tachycardia. Echocardiography showed no intracardiac
thrombus, signs of systolic dysfunction or heart failure. Conversion to
sinus rhythm could not be achieved with cardioversion. She underwent
ablation procedure after one month of palpitation symptoms. CARTO 3
systems (Biosense Webster, Inc., Diamond Bar, CA, USA) is used for the
three-dimensional mapping with Thermocool Smarttouch SF catheter.
Reference catheter could not be inserted due to absence of hepatic
portion of IVC. Ablation catheter inserted through right subclavian vein
with a The Agilis™ NxT Steerable Introducer. A quadripolar catheter
(Esolo FIAB, Italy) was inserted into esophagus as a reference catheter
(figure 1). The tachycardia cycle length was measured as 280 ms with 2:1
AV conduction. The activation and propagation mapping revealed that the
early-meets-late line was in the cavotricuspid isthmus region. In the
voltage mapping, a widespread and patchy-style scar area was detected in
the both atria. Cavotricuspid isthmus ablation was performed and sinus
rhythm was achieved. There was no complication related to procedure.