Cavotricuspid isthmus ablation guided by electroanatomic mapping in a patient with a mechanical tricuspid valve replacement after a total correction of tetralogy of Fallot.

Atrial arrhythmias are a common sequel after surgery for congenital heart disease, and often eventually cause late morbidity and mortality. Nowadays, percutaneous catheter ablation of atrial flutter (AFL) is widely practised, and is highly successful and safe. Patients with a tricuspid valve replacement (TVR) represent a distinct group for whom the appropriate nonpharmacologic therapy for AFL has not yet been established. We report a case of a 55-year-old woman with a history of a total correction of tetralogy of Fallot (ToF) who developed AFL before and after receiving a tricuspid valve prosthesis. Based on the results of the activation mapping, counterclockwise and clockwise AFL were identified. Completion of a cavotricuspid isthmus (CTI) line on the atrial side successfully terminated the AFL, with resumption of sinus rhythm. Guided by a 3D mapping system, CTI ablation is feasible and safe in patients with a prosthetic tricuspid valve.