Ablation of Ventricular Tachycardia in Transposition of the Great Arteries After Réparation à l’étage ventriculaire Procedure

Background: D-transposition of the great arteries is a complex congenital heart disease characterized by discordant ventriculoarterial connections. Surgical reconstruction of the right ventricular outflow tract with prosthetic material may create anatomic isthmuses that sustain ventricular tachycardia (VT). Case Summary: A patient with a history of D-transposition of the great arteries, corrected with the Réparation à l'Etage Ventriculaire procedure, underwent VT ablation for out-of-hospital cardiac arrest via single jugular access. VT mapped at the anatomic isthmus between the neo–pulmonary valve and the right ventricular septal patch effectively rendered VT noninducible despite aggressive stimulation protocols and isoproterenol infusion. Stenotic right ventricular outflow tract revalving was performed after the ablation procedure. Discussion: In the literature, no case reports are available on transcatheter ablation of VT after the Réparation à l'Etage Ventriculaire procedure. This case raises the question of whether patients with congenital heart defects other than tetralogy of Fallot should undergo a prophylactic electrophysiological study. Take-Home Messages: Similarities among different congenital defects may prompt preoperative electrophysiological evaluation. outflow.