EAM ‐ CT Merge Guiding a Safe Transeptal Puncture in Atrial Tachycardia Ablation in a Intracardiac Fontan Patient

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Atrial tachycardia in an intracardiac Fontan patient (n=1). Intervention: EAM-CT merge guiding transeptal puncture and radiofrequency catheter ablation. Primary outcome: Restoration of sinus rhythm.

Q: What does this research mean for the field?

The merge of CT with electroanatomical mapping guided safe transeptal puncture in a Fontan patient during atrial tachycardia ablation, achieving sinus rhythm restoration. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Marco Scaglione; Francesco Geuna; Enrico Guido Spinoni; Andrea Lamanna; Alberto Battaglia; Marco Gagliardi; Natascia Cerrato; Domenico Caponi

doi:10.1002/ccr3.70690

February 1, 2026Clinical Case ReportsOpen Access

EAM ‐ CT Merge Guiding a Safe Transeptal Puncture in Atrial Tachycardia Ablation in a Intracardiac Fontan Patient

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Key result

CT-EAM merge guides safe transeptal puncture to restore sinus rhythm during Fontan atrial tachycardia ablation.

n=1

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Key Points

To describe the integration of 3D computed tomography rendering with electroanatomical mapping to guide a transeptal puncture during atrial tachycardia ablation in a patient with an intracardiac Fontan conduit.
Evaluated a 39-year-old male with tricuspid valve atresia and pulmonary artery valve stenosis who underwent total cavo-pulmonary circulation with an unfenestrated intracardiac conduit and developed drug-refractory atrial tachycardia (N=1).
Acquired a preprocedural ECG-gated CT scan with 3D chamber segmentation and performed electroanatomical mapping (CARTO3) of the Fontan conduit in sinus rhythm.
Merged the 3D CT reconstruction with the electroanatomical map to target the transeptal puncture site into the left atrium without using intracardiac or transesophageal echocardiography.
The electroanatomical map and 3D CT merge accurately visualized the conduit, surgical patch, and left atrium, enabling successful and safe transeptal puncture.
Electroanatomical activation mapping during tachycardia identified a reentrant circuit with a critical isthmus in the lateral portion of the Fontan conduit.
Radiofrequency catheter ablation delivered at the critical isthmus terminated the arrhythmia and restored sinus rhythm.

Study Design

Type

Case Report (n=1)

Structured PICO

P

Population

1 male patient with tricuspid valve atresia and an unfenestrated intracardiac Fontan conduit experiencing poorly tolerated atrial tachycardia.

I

Intervention

Radiofrequency catheter ablation guided by electroanatomical map (EAM) and computed tomography (CT) 3D rendering merge for safe transeptal puncture without intracardiac and/or transesophageal echocardiography.

O

Outcome

Restoration of sinus rhythm and interruption of atrial tachycardia

EAM-CT merge can safely guide transeptal puncture without echocardiography for catheter ablation of atrial tachycardia in patients with complex intracardiac Fontan anatomy.

Implication

May support EAM-CT merge for transeptal access in select Fontan cases; leaves open generalizability pending prospective validation.

Abstract

A patient with tricuspid valve atresia and pulmonary artery valve stenosis underwent a total cavo‐pulmonary circulation with an unfenestrated intracardiac conduit. He experienced poorly tolerated atrial tachycardia and was referred for radiofrequency catheter ablation (RFCA). No interatrial shunt was evident. Before the procedure, a computed tomography (CT) scan with 3D rendering was performed. At the time of the procedure, the 3D rendering was merged with an electroanatomical map (EAM) performed by CARTO3 in sinus rhythm (SR). The merge guided the identification of the exact target point for a safe transeptal puncture, without using intracardiac and/or transesophageal echocardiography. The EAM during the tachycardia showed a reentrant circuit with a critical isthmus in the lateral portion of the Fontan conduit, and RFCA was performed restoring SR.

Discussion

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Cite This Study

Scaglione et al. (2026) conducted a case report in Atrial tachycardia in an intracardiac Fontan patient (n=1). EAM-CT merge guiding transeptal puncture and radiofrequency catheter ablation was evaluated on Restoration of sinus rhythm. EAM-CT merge successfully guided a safe transeptal puncture without echocardiography, allowing radiofrequency catheter ablation to restore sinus rhythm in a patient with an intracardiac Fontan.

synapsesocial.com/papers/69843383f1d9ada3c1fb0ba8 https://doi.org/10.1002/ccr3.70690

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EAM ‐ CT Merge Guiding a Safe Transeptal Puncture in Atrial Tachycardia Ablation in a Intracardiac Fontan Patient

Figures

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

EAM ‐ CT Merge Guiding a Safe Transeptal Puncture in Atrial Tachycardia Ablation in a Intracardiac Fontan Patient

Figures

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

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