RT Book, Section
A1 Amin, Anish
A1 Kalbfleisch, Steven
A1 Kertesz, Naomi J.
A2 Daniels, Curt J.
A2 Zaidi, Ali N.
SR Print(0)
ID 1128634509
T1 ARRHYTHMIAS IN ADULT CONGENITAL HEART DISEASE
T2 Color Atlas and Synopsis of Adult Congenital Heart Disease
YR 2016
FD 2016
PB McGraw-Hill Education
PP New York, NY
SN 9780071749435
LK accesscardiology.mhmedical.com/content.aspx?aid=1128634509
RD 2024/04/19
AB KG  is  a  38-year-old  woman  with  the  diagnosis  of  transposition  of  the  great  arteries  (TGA).  She  underwent  an  atrial  switch  operation  at  age  2  (Figure  13-1).  Her  first  episode  of  atrial  flutter  occurred  at  age  11  and  was  refractory  to  antiarrhythmic  drug  therapy  with  multiple  cardioversions  and  ultimately  required  permanent  pacemaker  implant  to  support  drug  therapy.  A  prior  electrophysiologic  (EP)  study  and  radiofrequency  ablation  (RFA)  was  unsuccessful.  She  recently  had  an  episode  of  atrial  flutter  while  taking  sotalol  120  mg  bid  and  metoprolol  12.5  mg  daily.  Her  symptoms  abruptly  began  with  exertion  and  including  dizziness  and  dyspnea  associated  with  ventricular  rates  greater  than  200  bpm  (Figure  13-2).  She  underwent  cardioversion  and  beta-blocker  dose  titration  but  unfortunately  could  not  tolerate  higher  beta-blockade.  She  was  subsequently  referred  for  repeat  EP  study.  Two  separate  arrhythmias  were  induced,  an  atrial  tachycardia  that  had  not  been  seen  clinically  (Figure  13-3)  and  atrial  flutter  (Figures  13-4  and  13-5).  Mapping  was  initially  performed  on  the  systemic  venous  side  and  the  atrial  tachycardia  location  was  identified  and  ablated.  In  order  to  map  the  atrial  flutter  a  transbaffle  puncture  was  performed  to  access  the  tricuspid  valve  and  the  pulmonary  venous  side  (Figure  13-6).  Entrainment  mapping  was  used  to  identify  the  circuit  (Figure  13-5).  The  atrial  flutter  was  successfully  ablated  (Figure  13-7)  by  placing  lesions  from  the  inferior  vena  cava  (IVC)  to  the  baffle  on  the  systemic  venous  side  and  then  from  the  baffle  to  the  tricuspid  valve  on  the  pulmonary  venous  side  (Figure  13-8).  She  has  since  had  no  recurrence  of  her  atrial  flutter.