triple atrial tachyarrhythmias in a patient with atrial septal defect (asd) post closure: a case report

Atrial septal defect (asd) is the most common congenital heart defect and is frequently associated with atrial tachyarrhythmias, both before and after closure. arrhythmias may persist or emerge despite the anatomical correction, particularly when the closure is performed later in life. triple atrial tachyarrhythmias are uncommon after asd closure, which typically present with a single dominant arrhythmia due to long-term right atrial remodeling. a 51-year-old woman with a history of asd closure using an amplatzer septal occluder (aso) in 2005 presented with recurrent palpitations and documented episodes of supraventricular tachycardia (svt). the first electrophysiology study (eps) revealed atrial tachycardia (at) and dual av nodal physiology. a follow-up eps with 3d activation mapping identified three distinct arrhythmia mechanisms: reverse typical atrial flutter originating from the cavotricuspid isthmus, focal at at the coronary sinus ostium, and typical av nodal reentrant tachycardia (avnrt). stepwise catheter ablation guided by 3d activation mapping successfully targeted all three circuits, restoring and maintaining sinus rhythm. this case emphasizes the value of thorough electrophysiological assessment in managing complex arrhythmias after asd closure. ablation guided by 3d mapping provides a precise and effective treatment, potentially reducing symptoms and long-term drug use. while catheter ablation is effective for single arrhythmia types, predicting outcomes in triple atrial tachyarrhythmias remains challenging.