title: Ventricular location of a part of the right atrial isthmus after tricuspid valve replacement for Ebstein's anomaly: a challenge for atrial flutter ablation.
abstract: We report the case of a patient with atrial flutter late after tricuspid valve replacement for Ebstein's anomaly. Computed tomographic angiography revealed that coronary sinus ostium and part of the right atrial isthmus were located on the ventricular side of the valve ring due to the specific surgical approach in this condition. Based on the results of electroanatomic mapping and entrainment, the arrhythmia was found to be cavotricuspid isthmus dependent clockwise atrial flutter. Completion of the isthmus line required ablation lesions across the artificial valve. When these were delivered the arrhythmia terminated and isthmus block was achieved. Due to arrhythmia recurrence a redo procedure was performed which demonstrated conduction recovery in the ventricular part of the cavotricuspid isthmus. Intracardiac ultrasound-guided ablation successfully eliminated conduction across the isthmus with subsequent freedom from arrhythmia on follow up.
authors.affiliation: Second Department of Internal Medicine and Cardiology Centre, University of Szeged, Korányi fasor 6, 6720, Szeged, Hungary.
authors.forename: Vassil Borislavov
authors.initials: VB
authors.lastname: Traykov
authors.forename: Róbert
authors.initials: R
authors.lastname: Pap
authors.forename: Gábor
authors.initials: G
authors.lastname: Bencsik
authors.forename: Attila
authors.initials: A
authors.lastname: Makai
authors.forename: Tamás
authors.initials: T
authors.lastname: Forster
authors.forename: László
authors.initials: L
authors.lastname: Sághy
mesh_terms: D000328:Adult; D001282:Atrial Flutter / Q000175:diagnosis / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000379:methods*; D004437:Ebstein Anomaly / Q000601:surgery*; D005260:Female; D006325:Heart Atria / Q000601:surgery*; D006329:Heart Conduction System / Q000002:abnormalities* / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D025321:Surgery, Computer-Assisted / Q000379:methods; D016896:Treatment Outcome