AV nodal ablation in tricuspid atresia; anatomical challenges

Patients with congenital heart disease often present unique challenges, especially in the electrophysiology laboratory. Here we present a case of a patient with medically refractory symptomatic atrial tachycardia, tricuspid atresia and a history of a modified Fontan procedure. The approach of an AV node ablation for palliation in our patient was met with challenges in identification of a His-bundle recording and successful ablation after identification of the His-bundle recording from a left sided approach. Although a left sided approach is feasible, an anatomically guided right sided approach to ablate the compact AV node may be preferred.