Aims The ideal pacing strategy has been the Achilles’ heel for patients with congenitally corrected transposition of great arteries (ccTGA) with bradycardia. Various pacing modalities were documented in the literature. This article describes a novel pacing strategy and its feasibility in ccTGA with an intact ventricular septum. Methods and results We prospectively recruited three patients with ccTGA who presented with symptomatic complete heart block to our institute and were evaluated. All patients were planned for conduction system pacing. Those who had more than moderate or severe systemic atrioventricular regurgitation and systemic ventricular dysfunction were planned for conduction system pacing with an additional lead in the coronary sinus (CS) tributary, i.e. bundle branch pacing optimized cardiac resynchronization therapy with the intention to achieve incremental benefit. Since right bundle pacing is not described previously and in view of anatomical complexity in location, three-dimensional (3D) anatomical mapping was done with the EnSite system and later right bundle capture is identified conventionally as that of a left bundle in a normal heart. All three patients have stable lead positions and adequate thresholds at short-term follow-up. Conclusion In this report, we demonstrated the feasibility of permanent physiological pacing of the systemic ventricle by capturing the right bundle with 3D anatomical mapping guidance, which results in physiological activation of the systemic ventricle.

We present a rare case of tachycardiomyopathy in a 4-year-old girl. The child had incessant atrial tachycardia (AT) and refractory heart failure. Right atrial appendage (RAA) was localised as the source of the ectopic tachycardia. The child underwent successful radiofrequency ablation (RFA) using 3-D electroanatomical mapping. Fluoroscopy was used sparingly only to rule out underlying anomalies. The left ventricular functions returned to normal by one month after the procedure. RAA AT is rare in very young children and usually necessitates surgical appendectomies. RFA is a challenge in such age groups and there are very few published literature on RAA AT in very young children.

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A B S T R A C TContext: Radiofrequency ablation (RFA) is a recognised mode of therapy for cardiac arrhythmias. The procedure is carried our regularly at the Cardiac Catheterization Laboratory of Madras Medical Mission, India. Aim: To evaluate the intermediate term follow-up results of radiofrequency catheter ablations. Subjects and Methods: This was a retrospective study carried out in the Cardiac Electrophysiology Department of the Institute of Cardiovascular Diseases, Madras Medical Mission (MMM), India.Records of consecutive cardiac electrophysiologic studies carried out between January and October 2009, together with records of follow-up to March 2014 for those that underwent RFAs were reviewed. In total, the records of 139 cases that had RFAs were analysed. Results: The 139 patients comprised of 65 males and 74 females. The indication for RFA was drug refractory arrhythmias in the vast majority (137 patients). There was a very high success rate (97.1%), following cardiac ablations. Early complications were observed in only 3 (2.2%) patients. Recurrence rate of the indication for RFA was very low (1.43%), and there was no mortality associated with the procedure. Conclusions: The treatment of patients with cardiac arrhythmias using RFA, was associated with a high rate of success, and low rate of complications.

Background:Cardiac electrophysiologic study and radiofrequency ablation (RFA) have become an established mode of treatment for patients with refractory arrhythmias. These procedures are carried out regularly at the cardiac catheterization laboratory of Madras Medical Mission India.Objective:The purpose of this study was to evaluate our experience with cardiac electrophysiologic studies (EPS) and RFA catheter of atrial fibrillation (AF).Materials and Methods:This was a retrospective study carried out in the Cardiac Electrophysiology Department of the Institute of Cardiovascular Diseases, Madras Medical Mission, India. All cases diagnosed to have AF following cardiac EPS between January 2010 and April 2014 was selected for the study. The records, which were obtained from the Cardiac Electrophysiology Clinical Research Office of Madras Medical Mission, were reviewed. Forty-nine cases were chosen for analysis, using SPSS statistical software version 15.Results:There were 49 patients, 23 males and 26 females. The mean age was 57.53 years. Commonly associated diseases were diabetes mellitus 8 (16.3%), hypertension 18 (36.7%), and coronary heart disease 14 (28.5%). The ventricular rate was rapid most cases (91.2%). AF was diagnosed as being paroxysmal in 40 (81.6%), persistent in 5 (10.2%), chronic in 3 (6.1%), and lone in 1 (2.0%). Ablation was carried out in 28 (57.1%), the success rate being 90% for pulmonary vein isolation, and 90.9% for atrioventricular node ablation. Complication rate was 2.04%.Conclusions:Treatment of AF by RFA is highly effective and safe.