M ustard repair for complete dextrotransposition of the great arteries (D-TGA) is associated with a 10% incidence of late recurrent atrial tachycardias.1 Most of these tachycardias (localized, as they are, in the pulmonary venous atrium) are not directly accessible for ablation and require either a retrograde approach or a transseptal approach. [2][3][4] We present a case of successful radiofrequency (RF) ablation of common atrioventricular nodal reentrant tachycardia (AVNRT), guided by nonfluoroscopic mapping with use of the EnSite NavX cardiac mapping system (St. Jude Medical, Inc.; St. Paul, Minn) in a patient who long before had undergone Mustard repair for D-TGA. Case ReportIn 2013, a 49-year-old woman with a 3-year history of recurrent supraventricular tachycardia at 175 beats/min (responsive to intravenous adenosine) was referred for catheter ablation. At the age of 4 years, she had undergone a Mustard repair for D-TGA. No detailed report of her surgical anatomy was available. Therefore, cardiac magnetic resonance imaging was performed before ablation: it showed the right and left pulmonary veins diverted to the right (pulmonary venous) atrium and the superior and inferior venae cavae (SVC and IVC) diverted by an atrial baffle to the left (systemic venous) atrium. A 12-lead electrocardiogram showed both sinus rhythm with criteria for right ventricular (RV) hypertrophy with right-axis deviation (Fig. 1A) and supraventricular tachycardia that suggested common AVNRT (Fig. 1B). During an electrophysiologic study performed after informed consent was obtained, diagnostic and ablation catheters were placed with use of fluoroscopy and were displayed on the screen of the EnSite NavX system. Via the right femoral vein, we deployed a 6F hexapolar catheter in the SVC for stimulation and recording from the pulmonary venous atrium, a 6F quadripolar catheter for stimulation and recording Case Reports
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