Adenosine‐Sensitive Focal Atrial Tachycardia Late After Atriopulmonary Connection Fontan Procedure: A Case Report

Figures

• 

  FIGURE 1. Electrocardiography. (A) Twelve‐lead electrocardiography during sinus rhythm with 72 beats/min. (B) Twelve‐lead electrocardiography during narrow QRS complex tachycardia with 120 beats/min. (C) Continuous Six‐leads electrocardiography during the intravenous administration of adenosine 5′‐triphosphate for tachycardia. The tachycardia slowed down and terminated after the atrioventricular block. P (cyan) and P′ (magenta) indicate P wave during sinus rhythm and tachycardia. (D) Waveforms of the lead II during tachycardia and sinus rhythm. P′ wave during tachycardia shows a notch. PAC, premature atrial complex.

• 

  FIGURE 2. Three‐dimensional computed tomography. Anterior–posterior view (A) and modified caudal view (B) of the great arteries, cardiac chambers, and vena cava. Anterior–posterior view (C) and modified right lateral view (D) of the vena cava, right atrium, and pulmonary artery. Crista terminalis (dashed lines) separates the dilated sinus venosus and right atrial appendage. APC, atriopulmonary connection; CT, crista terminalis; IVC, inferior vena cava; PA, pulmonary artery; RA, right atrium; RAA, right atrial appendage; RV, right ventricle; SV, sinus venosus; SVC, superior vena cava.

• 

  FIGURE 3. Electroanatomical map of tachycardia (A), fluoroscopy images (B), and intracardiac electrogram (C, D). (A) Modified right lateral view of voltage map and activation map of the right atrium during tachycardia. The sinus venosus and the APC anastomosis also show a low‐voltage area. Crista terminalis (dashed lines) separates the sinus venosus and right atrial appendage. The earliest activation site (EAS) during the sinus rhythm is at the junction between the SVC and right atrium (black dot). The EAS during tachycardia is crista terminalis (cyan dot). (B) Fluoroscopy images of the success site. (C) The intracardiac electrogram shows the local electrogram of the EAS during tachycardia precedes the P wave by 125 ms. The unipolar electrogram shows a QS pattern. (D) Radiofrequency application (30 W) terminated the tachycardia and restored sinus rhythm after 2.2 s. EAS, earliest activation site; LAT, local activation time; SR, sinus rhythm; tachycardia cycle length. Other abbreviations are as in Figure 2.