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.