Radiofrequency ablation can successfully treat orthodromic reentrant tachycardia caused by an accessory pathway across a Fontan anastomosis suture line.
May offer ablation option in Fontan patients with accessory pathways; leaves open durability and generalizability beyond this case.
Supraventricular tachyarrhythmias following the Fontan procedure can be life-threatening. Though most are commonly due to intraatrial reentry, orthodromic reentrant tachycardia may also be present. Atrioventricular accessory pathways may develop across suture lines following right atrial to right ventricular anastomosis in patients with tricuspid atresia. We report a case of a patient who underwent this type of Fontan who developed orthodromic reentrant tachycardia and heart failure. An electrophysiological study revealed the presence of an atrioventricular accessory pathway traversing the Fontan anastomosis suture line. Successful radiofrequency ablation of the accessory pathway led to control of the tachyarrhythmia and improvement of heart failure.
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Liberman et al. (2000) studied this question.
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