Three-dimensional visualization of the left atrium by intracardiac echocardiography facilitates trans-septal catheterization and atrial fibrillation catheter ablation in cor triatriatum sinister: A case report and literature review

A key to the success of catheter ablation in complex congenital heart disease is an accurate delineation of the anatomy. Here we describe the efficiency of intracardiac echocardiogram in guiding the catheter ablation of persistent atrial fibrillation in a 55-year-old Japanese male with cor triatriatum sinister. Echo imaging provided a detailed three-dimensional anatomy of the whole left atrium and identified an ideal trans-septal puncture site that allowed catheter access to both the accessory and main chambers of the left atrium. We review similar cases from the literature. <Learning objective: Cor triatriatum sinister is a rare cardiac anomaly wherein a fibromuscular membrane divides the left atrium into two parts. An accurate delineation of the entire left atrial anatomy including the membrane by intracardiac echocardiography may facilitate the catheter ablation procedure of atrial fibrillation, especially when deciding the optimal trans-septal catheterization site to map both left atrial chambers.>.