[General Anesthesia for Magnetic Navigation System-guided Catheter Ablation in a Patient with Persistent Atrial Tachycardia and an Extracardiac Total Cavopulmonary Connection].

Abstract

Atrial arrhythmia is an important prognostic factor in patients undergoing the Fontan operation. Although catheter ablation is considered to be a curative treat- ment the anatomical constraints produced by extra- cardiac total cavopulmonary connection make it diffi- cult to insert catheters towards the right atrium. Mag- netic navigation systems enable safer catheter delivery to the target site in such cases. Catheter ablation was carried out under the guidance of a magnetic naviga- tion system after the Fontan conversion operation in a 39-year-old female patient with persistent atrial tachy- cardia for the first time in Japan. During a 3-hr period of atrial tachycardia (AT), the patient's hemodynamic status was severely compromised ; her systemic blood pressure fell below 80 mmHg, and her central venous pressure increased to 26 mmHg. After the termination of AT, the patient's hemodynamic status was normal- ized without any complications. The procedure was successful, and the patient was discharged as sched- uled. The number of catheter ablation procedures in patients with arrhythmia after the Fontan procedure is expected to increase as patients with complex congen- ital heart defects are surviving longer. It is important to clarify the issues associated with this procedure and establish a safe anesthetic management strategy based on hemodynamic data.