Slow pathway ablation using electro-anatomical mapping in a patient with corrected transposition of the great arteries, dextrocardia, and atrioventricular nodal reentrant tachycardia.

摘要

We reported a 26-year-old female with congenitally corrected transposition of the great arteries, dextrocardia, cardiac situs inversus, and episodes of supraventricular tachycardia (A). A three-dimensional (3D) reconstruction image was made by computed tomography (CT) scan showing the detailed structure of the defects (B, C). His bundle was located at the apex of the triangle of Koch (D, E). The electrophysiological study showed slow-fast type of atrio-ventricular nodal re-entrant tachycardia (AVNRT). Successful ablation of the slow pathway was performed using an electro-anatomical mapping system (F). After 22 months of follow-up, no recurrence was noted. Congenitally corrected transposition of the great arteries and dextrocardia accompanied by AVNRT is rare. It may be helpful to invert the fluoroscopic image left to right to simulate normal anatomy. Detailed structuring using a 3D reconstruction CT scan and electro-anatomical mapping system would be of help in ablation.