ArticleFrontiers in cardiovascular medicine2026
Case Report: Complex atrial arrhythmia ablation with transbaffle puncture in a Fontan patient with intracardiac lateral tunnel anatomy.
Article in Frontiers in cardiovascular medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Atrial arrhythmias are frequent and potentially life-threatening late sequelae in adults with Fontan physiology. We present the case of a 36-year-old woman with an intracardiac lateral tunnel Fontan and prior Amplatzer Septal Occluder closure of a residual fenestration, who developed recurrent, drug-refractory supraventricular tachycardia. High-density electroanatomical mapping revealed a macro-reentrant flutter circuit within the conduit, successfully interrupted with linear ablation. Preprocedural cardiac CT guided a transbaffle puncture, performed inferior and right to the occluder, enabling common atrial access. Subsequent mapping identified an additional macro-reentrant flutter and a focal atrial tachycardia, both ablated with restoration of stable sinus rhythm. No arrhythmias were inducible post-procedure. This case underscores the feasibility and safety of catheter ablation in complex Fontan anatomy when guided by meticulous anatomical assessment, tailored access, and advanced mapping technologies.
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