Ebstein anomaly with atrial tachycardia: Case submitted by James Oliver, MBChB, PhD, MRCP

1. Severe RV or left ventricular dysfunction and sustained VT should be an indication for ICD placement in patients with severe forms of CHD. 2. Avoid placing pacing or defibrillation leads through prosthetic AV valves. 3. In patients with severe recurrent atrial arrhythmias despite multiple therapies (drugs, catheter ablation, and surgery), it is important to keep considering repeat catheter ablation procedures with alternative technology as and when they become available. 4. Similarly, consideration should be given to referral to more specialized centers in such cases 5. VT in patients with Ebstein anomaly commonly arises from the diaphragmatic aspect of the atrialized RV and should be considered for catheter ablation.