Key result
Standalone pulsed field ablation successfully terminated incisional atrial flutter in an adult with d-TGA post-Mustard procedure, maintaining arrhythmia freedom at 4-month follow-up.
Why the study?
Little is known about the applicability of pulsed field ablation in adults with congenital heart disease and complex atrial arrhythmias.
Does standalone pulsed field ablation (PFA) successfully terminate and prevent recurrent atrial arrhythmia in adults with congenital heart disease (d-TGA post-Mustard procedure)?
Case Report (n=1)
Does standalone pulsed field ablation (PFA) successfully terminate and prevent recurrent atrial arrhythmia in adults with congenital heart disease (d-TGA post-Mustard procedure)?
A standalone PFA approach can successfully treat complex macro-reentrant atrial arrhythmias in adult patients with structural congenital heart disease such as a prior Mustard procedure.
The emergence of pulsed field ablation (PFA) has revolutionized atrial arrhythmia (AA) ablation practice, mainly in adults with normal structural hearts. Little is known about its applicability in adults with CHD. A 41-year-old male with d-transposition of the great arteries (d-TGA) status post Mustard procedure, with longstanding atrial arrhythmia and multiple prior ablations, presented with recurrent symptomatic AA refractory to medical therapy. Endocardial AA ablation was performed using a standalone PFA-based approach. Following comprehensive bilateral atrial mapping, a critical isthmus was identified along a prior incisional scar related to the interatrial baffle, consistent with incisional atrial flutter. Immediate termination was achieved following the first PFA delivery using a pentaspline catheter (FARAWAVE, Boston Scientific). Additional scar homogenization was delineated entirely with only PFA. The patient has remained clinically free from AA at 4-month follow-up. This case underscores the novelty and potential applicability of a standalone PFA approach not only in patients with normal cardiac structure, but also in adults with CHD.
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Kulthamrongsri et al. (2026) conducted a case report in Recurrent symptomatic atrial arrhythmia refractory to medical therapy in d-TGA post Mustard procedure (n=1). Standalone pulsed field ablation (PFA) was evaluated on Arrhythmia termination and freedom from atrial arrhythmia. Standalone pulsed field ablation successfully terminated incisional atrial flutter in an adult with d-TGA post-Mustard procedure, maintaining arrhythmia freedom at 4-month follow-up.
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