Electrophysiologic studies in tricuspid atresia

Introduction to the Congenital Heart Defects: Anatomy of the Conduction System

The position and course of the conduction system in congenital heart disease are intricately tied to the underlying congenital malformation. Although only subtle differences exist between the anatomy of the conduction axis for simple congenital heart lesions and normal anatomy, almost every patient with congenital heart disease harbors some important anatomic variation. This article summarizes the body of literature by retaining original classical concepts and by attempting to translate the available knowledge into useful points for the congenital heart disease specialist. This discussion spans the entire spectrum of simple to complex congenital heart disease.

Successful slow pathway ablation in a patient with a rare unroofed type coronary sinus

We report a case of atrioventricular nodal reentrant tachycardia coexistent with a coronary sinus (CS) anomaly. During a standard electrophysiological study, the CS could not be cannulated despite several attempts. A persistent left superior vena cava angiogram through the left brachial vein confirmed an unroofed type CS. Successful slow pathway ablation from the right posterior paraseptum lesion was achieved using an anatomical approach.

Ablation of Atrioventricular Nodal Reentrant Tachycardia in Tricuspid Atresia

A 31-year-old woman with tricuspid atresia and a palliative Waterston shunt presented with intractable poorly tolerated supraventricular tachycardia. Electrophysiologic evaluation was consistent with AV nodal reentrant tachycardia. The fast pathway region was mapped electroanatomically during tachycardia and with constant rate ventricular pacing. Successful radiofrequency ablation was achieved by placement of lesions in an area adjacent and inferior to the His-bundle electrogram on the left side of the septum.