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The management of supraventricular arrhythmias after the Fontan procedure with catheter ablation represents a significant challenge. This can be due to the access problems that are created by the currently used modification of the procedure, which uses an extracardiac conduit, as well as to the complex anatomic substrate that can be created by a combination of congenital and acquired reasons. We report a case illustrating both of these aspects of the procedure and the potential solutions to the problems.

Acquired right atrial appendage to right ventricle accessory pathway in a lateral tunnel Fontan patient: Successful ablation via transconduit approach