Ablation of Intra-Atrial Re-Entrant Tachycardia in an Adult With Double-Inlet Ventricle Using Pulsed-Field Ablation

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Intra-atrial re-entrant tachycardia in adult congenital heart disease (n=1). Intervention: Pulsed-field ablation. Primary outcome: Arrhythmia termination and recurrence.

Q: What does this research mean for the field?

Pulsed-field ablation can safely and successfully terminate refractory intra-atrial re-entrant tachycardia in patients with complex adult congenital heart disease. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Daniel Pipilas; Dingxin Qin; D. Dante Yeh; Michael Mansour

doi:10.1016/j.jaccas.2026.107390

March 1, 2026JACC Case ReportsOpen Access

Ablation of Intra-Atrial Re-Entrant Tachycardia in an Adult With Double-Inlet Ventricle Using Pulsed-Field Ablation

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Key result

Pulsed-field ablation terminates refractory IART in complex congenital heart disease with no recurrence at ~10 months.

n=1

Figures

Graphical abstract published by JACC Case Reports — Graphical abstract · Published by JACC Case Reports · CC BY-NC-ND

Why the study?

Supraventricular tachycardia causes high morbidity in adult congenital heart disease, but ablation poses challenges due to access difficulties, circuit variations, and risk of damaging surrounding structures.

Key Points

Evaluate the safety and feasibility of pulsed-field ablation for refractory intra-atrial re-entrant tachycardia in an adult with complex congenital heart disease following failed radiofrequency ablation.
Evaluated a 45-year-old man with double-inlet single ventricle, pulmonary atresia, and a modified Fontan presenting with recurrent supraventricular tachycardia despite prior radiofrequency ablation.
Performed high-density electroanatomic activation mapping and delivered pulsed-field ablation lesions using the Affera mapping system and a bidirectional Sphere-9 catheter via transbaffle access.
Activation mapping during burst atrial pacing identified a focal micro–re-entrant intra-atrial tachycardia circuit with a cycle length of 430 ms at the posterior right atrial-left atrial junction.
Delivery of pulsed-field ablation lesions along the systemic atrial surface and anatomical interatrial septum successfully terminated the intra-atrial re-entrant tachycardia circuit.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

A 45-year-old man with double-inlet single ventricle and refractory intra-atrial re-entrant tachycardia who was successfully treated with pulsed-field ablation and followed for 10 months.

I

Intervention

Pulsed-field ablation (PFA) using the Affera mapping and ablation system and Sphere-9 catheter

O

Outcome

Termination of tachycardia and recurrence of atrial arrhythmias

Pulsed-field ablation using a steerable mapping and ablation catheter can safely and effectively treat complex intra-atrial re-entrant tachycardias in adults with complex congenital heart disease.

Limitations

Ablation with pulsed-field ablation can stun the myocardium, which can affect the interpretation of electrograms during the procedure.
The immediate effects of pulsed-field ablation on tissue may not predict durable ablation lesions or provide prognostic information on successful ablation.
The Affera mapping system is not presently able to visualize other catheters, which can pose challenges when interpreting maneuvers before and after ablation.
Ablation with PFA can stun the myocardium, which can affect the interpretation of electrograms during the procedure
Immediate effects of PFA on the tissue may not predict durable ablation lesions or provide prognostic information on successful ablation
Affera mapping system is not presently able to visualize other catheters, posing challenges when interpreting maneuvers before and after ablation

Implication

Pulsed-field ablation may succeed where radiofrequency fails in complex CHD-related IART; hypothesis-generating pending larger studies.

Abstract

BACKGROUND: Supraventricular tachycardia is common in patients with adult congenital heart disease and carries a high morbidity. Ablation of these arrhythmias is an effective treatment strategy, but difficulty accessing the cardiac chambers, variations in electroanatomical circuits, and concerns of damaging the surrounding structures can pose procedural challenges. CASE SUMMARY: A 45-year-old man with complex congenital heart disease and intra-atrial re-entrant tachycardia initially underwent ablation with radiofrequency energy but experienced clinical recurrence. He presented for a second procedure using pulsed-field ablation (PFA), which was successful. DISCUSSION: PFA is emerging as a safe and effective energy delivery system for ablation of different cardiac arrhythmias. It may be effective in adult congenital heart disease patients with atrial fibrillation. TAKE-HOME MESSAGE: PFA is safe and effective for treatment of supraventricular tachycardia in the adult congenital heart disease population.

Discussion

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Cite This Study

Pipilas et al. (2026) conducted a case report in Intra-atrial re-entrant tachycardia in adult congenital heart disease (n=1). Pulsed-field ablation was evaluated on Arrhythmia termination and recurrence. Pulsed-field ablation successfully terminated refractory intra-atrial re-entrant tachycardia in a 45-year-old man with complex congenital heart disease, with no recurrence after 10 months.

synapsesocial.com/papers/69ba425c4e9516ffd37a2932 https://doi.org/10.1016/j.jaccas.2026.107390

Topics

Congenital heart disease adults

AF ablation outcomes

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Ablation of Intra-Atrial Re-Entrant Tachycardia in an Adult With Double-Inlet Ventricle Using Pulsed-Field Ablation

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

Ablation of Intra-Atrial Re-Entrant Tachycardia in an Adult With Double-Inlet Ventricle Using Pulsed-Field Ablation

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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