Successful ablation of two right atrial tachycardias on either side of the lateral tunnel patch in a patient with double inlet left ventricle and total cavopulmonary connection: Two sites and two mechanisms

INTRODUCTION Surgical strategy for patients born with a physiological univentricular heart has evolved from atrio-pulmonary (AP) Fontan (right atrium (RA) to pulmonary artery) to its modification, total cavopulmonary connection (TCPC), with the goal of reduced post-operative incidence of supraventricular tachycardia (SVT). However, TCPC patients may also present with symptomatic atrial tachycardia, and the sites of origin can be difficult to access due to the surgical strategy. Owing to recent technological advances in the field of electrophysiology, such as electroanatomic mapping (EAM), irrigated-tip catheters and remote magnetic navigation (RMN), catheter ablation has become a more relevant and important therapeutic modality for congenital heart disease associated-SVTs. We report on a 33-year-old male, with double inlet left ventricle (DILV) status post TCPC, who underwent catheter ablation of two different atrial tachycardias originating in different parts of the divided RA.