Radiofrequency Ablation of Accessory Pathways in Children with Complex Congenital Cardiac Lesions: A Report of Three Cases
A 9-year-old girl, weighing 30 kg, presented with recurrent palpitations. Electrocardiography during sinus rhythm revealed a manifest posteroseptal AP (). In the past, she had been diagnosed to have tricuspid atresia (type Ib) with normally-related great arteries, a small ventricular septal defect, and pulmonary stenosis. She had previously undergone extracardiac total cavopulmonary connection and was awaiting fenestration closure with device (because of cyanosis). We conducted an electrophysiological study and documented orthodromic atrioventricular reentrant tachycardia. There were two approaches to the ventricle: 1) from the inferior vena cava into the intracardiac tunnel, fenestration, atria, and left ventricle, respectively; and 2) via the retrograde aortic approach. We opted to ablate the AP via the retrograde approach on account of its less complexity but failed to obtain appropriate signals, containing atrial electrogram. We were, therefore, obliged to resort to the antegrade approach and pass the ablation catheter through the fenestration ( and ). We subsequently ablated the left posteroseptal AP from the atrial aspect of the annulus (). The procedure time was 90 minutes, and the fluoroscopy time was 22 minutes.