Related Experiment Video
Updated: Jan 9, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Catheter Ablation of Baffle-Crista Suture-Related Macro-Re-Entrant Flutter in a Lateral Tunnel Fontan Patient
Xiaofeng Hu1, Weifeng Jiang1, Xu Liu1
1Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Background:
Atrial tachycardia is a frequent late complication after Fontan surgery, with complex mechanisms involving scars and baffle suture lines.
Case Summary:
A 42-year-old man with prior lateral tunnel Fontan presented with recurrent supraventricular tachycardia at 180 beats/min. Coronary sinus catheterization was not feasible. Intracardiac echocardiography (ICE) showed the right atrium divided by the baffle into caval and pulmonary venous chambers. Activation mapping revealed extensive low-voltage substrate, with ∼70% of the tachycardia cycle length localized to the pulmonary venous right atrium. Entrainment responses were consistent at several sites but poor at others, indicating a macro-re-entrant circuit revolving around the baffle-crista terminalis suture line. Linear ablation across this isthmus terminated flutter; tachycardia was noninducible thereafter.
Discussion:
This case illustrates a rare mechanism of Fontan-related flutter, defined by ICE and entrainment, emphasizing the need to consider baffle-related circuits in complex anatomies.
Take-Home Message:
Baffle-related macro-re-entry should be suspected in patients who underwent lateral tunnel Fontan; ICE plus entrainment can guide effective ablation.
