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 


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© Springer-Verlag Italia 2008

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