Two Macroreentrant Tachycardias in a Patient after Fontan Surgery: the Difference between “Isthmic” and “Rotational” Atrial Macroreentry


This is a 21-year-old male patient with complex congenital heart disease that included a single ventricle, transposition of the great vessels, pulmonary valve stenosis and persistence of the left superior vena cava. At the age of four, he underwent a Fontan operation, consisting of insertion of the left superior vena cava in the left pulmonary artery and of the right superior vena cava in the right pulmonary artery, with direct closure of its orifice in the right atrium. The right atrium was connected through a conduit to the pulmonary artery. In the same intervention, the tricuspid orifice was closed by a prosthetic patch in order to separate venous from arterial blood flow. Six months before the procedure, the patient had episodes of typical atrial flutter (Fig. 1) with a cycle length of 285 ms and 2:1 atrioventricular conduction. In spite of amiodarone therapy, the arrhythmia recurred and was responsible for syncope and initial-stage congestive heart failure. Therefore, the patient was admitted for an electrophysiologic procedure.


Atrial Flutter Fontan Surgery Fontan Patient Left Anterior Oblique Pulmonary Valve Stenosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Earing MG, Cetta F, Driscoll DJ et al. Long-term results of the Fontan operation for double-inlet left ventricle. Am J Cardiol 2005; 96: 291–298.PubMedCrossRefGoogle Scholar
  2. 2.
    Chan DP, Van Hare GF, Mackall JA et al. Importance of atrial flutter isthmus in postoperative intraatrial reentrant tachycardia. Circulation 2000; 102: 1283–1289.PubMedGoogle Scholar
  3. 3.
    Collins KK, Love BA, Walsh EP et al. Location of acutely successful radiofrequency catheter ablation of intraatrial reentrant tachycardia in patients with congenital heart disease. Am J Cardiol 2000; 86: 969–974.PubMedCrossRefGoogle Scholar
  4. 4.
    Abrams D, Schilling R. Mechanism and mapping of atrial arrhythmia in the modified Fontan circulation. Heart Rhythm 2005; 2: 1138–1144.PubMedCrossRefGoogle Scholar
  5. 5.
    Jaïs P, Shah DC, Haïssaguerre M et al. Mapping and ablation of left atrial flutters. Circulation 2000; 101: 2928–2934.PubMedGoogle Scholar
  6. 6.
    De Ponti R, Verlato R, Bertaglia E et al. Treatment of macroreentrant atrial tachycardia based on electroanatomic mapping: identification and ablation of the mid-diastolic isthmus. Europace 2007; 9: 449–457.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2008

Personalised recommendations