Ablate and pace as bail-out therapy in a patient with Fontan correction and malignant atrial tachycardia

Area of Science:

• Cardiology
• Pediatric Cardiac Surgery
• Electrophysiology

Background:

• Atrial tachyarrhythmias pose a significant risk in Fontan patients, often leading to hemodynamic compromise.
• Current treatments include surgical interventions and transcatheter ablation, but refractory cases remain challenging.

Observation:

• A patient with a history of atriocaval Fontan correction developed recurrent, severe atrial tachycardia causing syncope.
• Previous surgical conversion attempts were unsuccessful, and the patient was awaiting heart transplantation.

Findings:

• A novel approach involving atrioventricular node ablation via a retrograde aortic route and ventricular pacing through the coronary sinus was performed.
• The patient demonstrated stable functional recovery and excellent lead performance one year post-procedure.

Implications:

• This 'ablate and pace' strategy offers a potential life-saving option for Fontan patients with refractory, malignant atrial arrhythmias.
• This approach may be a valuable bridge therapy while awaiting heart transplantation or for select patients unsuitable for other interventions.