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A 44-year-old man with a history of complex congenital heart disease, including a functionally univentricular heart, dextrocardia, and situs ambiguous with the right atrium (RA) and superior vena cava to inferior vena cava (IVC) on the left, and the left atrium (LA) on the right and posteriorly, and multiple cardiac surgeries, developed an atrial tachycardia (AT), and underwent electrophysiological testing. He had undergone right Blalock–Taussig shunt at the age of 4, modified Fontan at the age of 15, and conversion of the Fontan to a total cavopulmonary connection (TCPC) with an extra-anatomic conduit from the IVC to pulmonary artery (PA), bidirectional Glenn shunt, and right and limited left Maze procedure at the age of 36. The pre-procedural computed tomography images revealed that the RA was completely separated into two components after the TCPC with the internal baffle (Figure 1). This finding suggested that a transvenous approach could not reach the pulmonary venous atrium (PVA). During the electrophysiological study, a decapolar catheter was placed in the PA through the baffle to record the LA electrogram as a reference for 3D mapping. Activation mapping was performed with a contact force sensing ablation

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Successful catheter ablation of a focal atrial tachycardia originating from the coronary sinus ostium in a patient with a history of Fontan conversion and dextrocardia