This case demonstrates that AV reentrant tachycardia mediated by an accessory pathway can occur in patients with d-TGA post-Mustard repair, highlighting the critical role of electrophysiology maneuvers for accurate diagnosis and successful ablation.
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Typical AVNRT may occur post-Mustard; leaves open tailored ablation strategies in d-TGA.
Tabled 1KEY TEACHING POINTS•Owing to atrial dilatation and fibrosis following surgical incisions and baffle creation, intra-atrial reentrant tachycardia is by far the most common arrhythmia seen following Mustard repair for dextro-transposition of the great arteries (d-TGA).•Typical AV nodal reentrant tachycardia has been reported following Mustard repair and, although accessory pathways are more common in patients with congenitally corrected transposition of the great arteries and Ebstein’s anomaly, this case shows AV reentry tachycardia is possible in a patient with d-TGA.•Advancing atrial activation during supraventricular tachycardia when the His bundle is refractory proves the presence of an accessory pathway. Other observations/maneuvers such as the change in VA interval with ipsilateral bundle branch block and the capacity to entrain the tachycardia from the site of the pathway with a short post-pacing interval help to prove accessory pathway participation and define the target for ablation. Open table in a new tab
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Jackson et al. (2016) studied this question.
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