Arinze Nkechi Christiana, Eyituoyo Harry O, Aben Rieta N, Vu Dat P, Haithcock Daniel B, Poku Joseph, Sogade Felix O
Department of Internal Medicine/Community Medicine, Mercer University School of Medicine, Macon, GA, USA.
Department of Cardiology and Electrophysiology, Georgia Arrhythmia Consultants and Research Institute, Macon, GA, USA.
Am J Case Rep. 2020 Dec 2;21:e928147. doi: 10.12659/AJCR.928147.
BACKGROUND Radiofrequency ablation (RFA) is the criterion standard treatment for patients with atrioventricular nodal reentrant tachycardia (AVNRT). Knowledge about RFA in patients with dextrocardia and situs inversus is limited due to their rare incidence and complexity. The incidence of dextrocardia is reported to be 1 in 12 000 births, with situs inversus occurring in one-third of the cases. The incidence of congenital heart disease is about 5% in these patients. However, data on rhythm and conduction disorders in this group of patients are currently limited, making management more difficult owing to their individual anatomy. CASE REPORT We report the case of an obese 21-year-old man with complex congenital heart disease (CCHD) (situs inversus dextrocardia, pulmonary atresia, single ventricle, common atrium with single atrioventricular valve), asplenia, and multiple cardiac-corrective surgeries (Fontan repair, bidirectional Glenn anastomosis, and Blalock-Taussig shunt) who underwent successful RFA of recurrent supraventricular tachycardia. CONCLUSIONS Supraventricular arrhythmias are common in the setting of CCHD. Although catheter ablation procedures are technically challenging to perform in patients with CCHD, they remain the best therapeutic option for these arrhythmias. To our knowledge, this case is the first to be described in the literature of successful ablation of AVNRT in a patient with situs inversus dextrocardia, pulmonary atresia, a single ventricle, a common atrium with a single atrioventricular valve, and multiple cardiac-corrective surgeries.
射频消融术（RFA）是房室结折返性心动过速（AVNRT）患者的标准治疗方法。由于右位心和内脏反位患者发病率低且病情复杂，关于此类患者射频消融术的知识有限。据报道，右位心的发病率为1/12000活产，其中三分之一伴有内脏反位。这些患者中先天性心脏病的发病率约为5%。然而，目前关于该组患者心律失常和传导障碍的数据有限，因其个体解剖结构使得治疗更加困难。病例报告：我们报告一例21岁肥胖男性患者，患有复杂先天性心脏病（CCHD）（右位心、内脏反位、肺动脉闭锁、单心室、共同心房伴单一房室瓣）、无脾症，且接受过多次心脏矫正手术（Fontan修补术、双向Glenn吻合术和Blalock-Taussig分流术），该患者复发性室上性心动过速经射频消融术治疗成功。结论：室上性心律失常在CCHD患者中很常见。尽管导管消融术在CCHD患者中技术操作具有挑战性，但仍是这些心律失常的最佳治疗选择。据我们所知，该病例是文献中首例报道的右位心、内脏反位、肺动脉闭锁、单心室、共同心房伴单一房室瓣且接受过多次心脏矫正手术的患者成功消融AVNRT的病例。
