Supraventricular Tachycardia in A Young Adult with Congenital Heart Disease: Successful Ablation after Patent Ductus Arteriosus Closure.

UNLABELLED: Arrhythmias in adults with congenital heart disease (ACHD) can occur due to remodelling and post-intervention injury. As ablation is the gold standard for arrhythmia intervention, finding the electrical source from ACHD can be challenging, especially after surgical repair. We present an ACHD with patent ductus arteriosus (PDA) without risk factor cardiovascular disease, with post-closure complaints of frequent palpitations and a history of supraventricular tachycardia (SVT) after transcatheter PDA closure; electrocardiography (ECG) shows SVT. Mean pulmonary arterial pressure (MPAP) was 81 mmHg before PDA closure and 64 mmHg after closure. The patient was planned for 2D ablation, and concentric coronary sinus activation was found. VAV activation showed PPI-TCL >115 ms, ventriculoatrial interval <70 ms, SVT AVNRT/AVRT with excluded AT (V-A stimulus 202 ms). ECG and electrogram after radiofrequency ablation show successful ablation with paroxysmal atrial tachycardia. Detailed examination of ECG and echocardiography with manoeuvres is important to distinguish concomitant arrhythmia or correlation in ACHD.

LEARNING POINTS: Managing adults with congenital heart disease (ACHD) can be challenging because of its various complication risks, with arrhythmias being common complication.An ablation technique for arrhythmia intervention in ACHD can be complex for the mapping of electric conduction based on the complex structural anatomy from congenital heart disease.Monitoring cardiac function after cardiac repair surgery among ACHDs is needed to reduce complication after surgery.