title: Atrial tachycardia ablation in a patient with double outlet right ventricle corrected by surgery.
abstract: The development of surgical and percutaneous techniques for treatment or palliation of congenital heart disease has prolonged survival in these patients and has increased late complications, particularly arrhythmias. Such arrhythmias are more frequently refractory to medical therapy, requiring percutaneous ablation. We present the clinical case of a 14-year-old child with complex congenital heart disease (double outlet right ventricle) who underwent two corrective surgeries (Rastelli operation and subsequent replacement of the homograft in the conduit connecting the right ventricle to the pulmonary artery; ventricular septal defect closure and tricuspid valve repair). After the second surgery the patient presented with wide complex syncopal tachycardia, refractory to medical therapy. Electrophysiologic study (EPS) identified an isthmus-dependent atrial flutter that was successfully treated by radiofrequency (RF) ablation (a linear block was created along the cavo-tricuspid isthmus). Three months later a new episode of tachycardia occurred, but without syncope. The second EPS revealed an atrial tachycardia originating from the lateral wall of the right atrium, which was treated by ablation with focal application of RF energy. Four months after the last EPS the child remains free of arrhythmic symptoms, under no anti-arrhythmic therapy.
authors.affiliation: Serviço de Cardiologia, Serviço de Cardiologia Pediátrica, Serviço de Cirurgia Cardiotorácica Hospital de Santa Cruz, Carnaxide, Portugal.
authors.forename: Katya
authors.initials: K
authors.lastname: Reis-Santos
authors.forename: Pedro
authors.initials: P
authors.lastname: Adragão
authors.forename: Diogo
authors.initials: D
authors.lastname: Cavaco
authors.forename: Isabel
authors.initials: I
authors.lastname: Menezes
authors.forename: José Pedro
authors.initials: JP
authors.lastname: Neves
authors.forename: Miguel
authors.initials: M
authors.lastname: Abecassis
authors.forename: Daniel
authors.initials: D
authors.lastname: Bonhorst
authors.forename: Queiroz João
authors.initials: QJ
authors.lastname: e Melo
authors.forename: Fernando Maymone
authors.initials: FM
authors.lastname: Martins
authors.forename: Ricardo
authors.initials: R
authors.lastname: Seabra-Gomes
mesh_terms: D000293:Adolescent; D017115:Catheter Ablation; D004310:Double Outlet Right Ventricle / Q000601:surgery*; D004562:Electrocardiography; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000601:surgery*; D013610:Tachycardia / Q000503:physiopathology / Q000601:surgery*