Pre-procedural imaging and atrial tachycardia ablation in a patient with complex congenital heart disease

Area of Science:

• Cardiology
• Cardiac Electrophysiology
• Congenital Heart Disease

Background:

• Atrial tachycardias (AT) are a frequent complication in patients with congenital heart disease (CHD).
• Reentrant AT mechanisms are often linked to surgical alterations like suture lines or scar tissue, causing atrial conduction abnormalities.
• Radiofrequency catheter ablation (RFCA) is a primary treatment for AT in CHD, but venous anomalies can complicate procedures.

Observation:

• A unique case of AT ablation in a patient with highly complex cardiac anatomy is presented.
• The patient exhibited a persistent left superior vena cava draining into the left atrium, coronary sinus agenesis, inferior vena cava (IVC) agenesis, and an azygos system draining to the superior vena cava.
• The patient had a history of a repaired ventricular septal defect.

Findings:

• Successful RFCA was performed despite the extremely rare and challenging venous anatomy.
• Key procedural considerations for cardiac chamber access and electrophysiological mapping in such complex cases were identified.

Implications:

• This report provides valuable insights into managing atrial tachycardia in CHD patients with complex venous system abnormalities.
• It underscores the importance of tailored strategies for electrophysiological procedures in patients with rare congenital cardiac variations.
• The findings contribute to the understanding of interventional approaches for arrhythmias in structurally abnormal hearts.