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Europace Advance Access originally published online on July 22, 2009
Europace 2009 11(9):1245-1247; doi:10.1093/europace/eup186
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

SHORT COMMUNICATIONS

Ablate and pace as bail-out therapy in a patient with Fontan correction and malignant atrial tachycardia

Paolo De Filippo, Paolo Ferrero, Adele Borghi, Roberta Brambilla and Francesco Cantù*

Cardiovascular Department Cardiac Electrophysiology, Ospedali Riuniti di Bergamo, Largo Barozzi 1, 24128 Bergamo, Italy

Atrial tachyarhthmias complicating Fontan correction may have a ‘malignant’ clinical presentation seriously impairing the patient haemodynamic. Current strategies are surgical total cavopulmonary connection with or without antiarrhythmic surgery or transcatheter ablation. We describe the case of a patient who previously underwent atriocaval Fontan correction and later presented with refractory atrial tachycardia responsible for relapsing syncope. After a failed attempt at surgical conversion, and while waiting for heart transplantation, he was submitted to ablation of the atrioventricular node through an aortic retrograde approach and ventricular pacing through the coronary sinus tree. One year later, the patient is doing well, displaying a stable functional recovery and excellent pacing lead performances. An ablate and pace approach may deserve consideration in selected Fontan patients experiencing life-threatening atrial arrhythmias.

* Corresponding author. Tel: +39 035 266594, Fax: +39 035 266826, Email: fcantu{at}ospedaliriuniti.bergamo.it

Manuscript submitted 24 March 2009. Accepted after revision 15 June 2009.


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