Successful Ablation of Ventricular Tachycardia in Repaired Tetralogy of Fallot via Transjugular and Subclavian Approach.

Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. Surgical repair with ventricular septal defect (VSD) patch and right ventricular outflow tract (RVOT) reconstruction is the only curative therapy. The population of adults with repaired Tetralogy of Fallot (rTOF) is growing due to the improvement of surgical technique. As a consequence, the increase burden of age-dependent ventricular arrhythmias (VAs) in patients with rTOF becomes an important reason for late morbidity and mortality. Notably, the vast majority of VAs in patients with rTOF are monomorphic ventricular tachycardias (VTs).1 Given the better understanding of the potential 4 anatomic isthmuses for VT circuits,2 catheter ablation has been implemented to be an effective and curative strategy to manage VTs in patients with rTOF, while clinical approaches are frequently achieved using femoral vein. However, clinical hurdle persisted once if patients with rTOF had limited vascular access. Here, we reported a challenging case with difficult vascular access owing to multiple occluded thrombosis and successful ablation of multiple monomorphic VT was performed using superior approach guided by merged intracardiac echocardiography (ICE) and reconstructed cardiac computed tomography (CT) image reconstruction in a case of rTOF.