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View full-text article in PMC

. 2009 Nov 1;9(6):299–317.

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Copyright: © 2009 Khairy et al.

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Catheter ablation in an extracardiac Fontan via a direct atriotomy approach. A patient with hypoplastic left heart syndrome and Ebstein's malformation of the right-sided AV valve had poorly tolerated incessant orthodromic AV reciprocating tachycardia postoperatively after an extracardiac Fontan with surgical accessory pathway ligation. In Panel A, an anteroposterior view is shown at the site of successful ablation, portraying the position of the radiofrequency ablation catheter (black arrow). The sternum is splayed open by means of thoracic retractors. Epicardial bipolar atrial and ventricular pacing leads are seen. Shown in Panel B are recordings from surface ECG leads II, aVL, and aVF; epicardial high right atrium (HRA); distal (MAP d) and proximal (MAP p) electrode pairs of the radiofrequency ablation catheter; and epicardial ventricle (RVA). Orthodromic AV reciprocating tachycardia is seen with the mapping catheter positioned at the site of successful ablation. Reproduced from Khairy P et al. Transcatheter ablation via a sternotomy approach as a hybrid procedure in a univentricular heart. PACE 2008;31(5):639-40, with permission from Wiley-Blackwell.