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  <front>
    <journal-meta>
      <journal-id journal-id-type="publisher-id">97</journal-id>
      <journal-id journal-id-type="index">urn:lsid:arphahub.com:pub:B5033382-9D21-53CE-B630-B4E3A1146D51</journal-id>
      <journal-title-group>
        <journal-title xml:lang="en">Bulgarian Cardiology</journal-title>
        <abbrev-journal-title xml:lang="en">Bulgarian Cardiology</abbrev-journal-title>
      </journal-title-group>
      <issn pub-type="ppub">1310-7488</issn>
      <issn pub-type="epub">2683-1015</issn>
      <publisher>
        <publisher-name>Bulgarian Society of Cardiology</publisher-name>
      </publisher>
    </journal-meta>
    <article-meta>
      <article-id pub-id-type="doi">10.3897/bgcardio.27.e71009</article-id>
      <article-id pub-id-type="publisher-id">71009</article-id>
      <article-categories>
        <subj-group subj-group-type="heading">
          <subject>Case Report</subject>
        </subj-group>
        <subj-group subj-group-type="scientific_subject">
          <subject>Arrhythmias (аритмии)</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title>Catheter ablation of macroreentrant atrial tachycardias following transconduit puncture access in a patient after total cavopulmonary connection with an extracardiac conduit</article-title>
      </title-group>
      <contrib-group content-type="authors">
        <contrib contrib-type="author" corresp="yes">
          <name name-style="western">
            <surname>Traykov</surname>
            <given-names>Vassil</given-names>
          </name>
          <email xlink:type="simple">vtraykov@yahoo.com</email>
          <uri content-type="orcid">https://orcid.org/0000-0002-9523-6416</uri>
          <xref ref-type="aff" rid="A1">1</xref>
        </contrib>
        <contrib contrib-type="author" corresp="no">
          <name name-style="western">
            <surname>Shalganov</surname>
            <given-names>Tchavdar</given-names>
          </name>
          <uri content-type="orcid">https://orcid.org/0000-0003-2268-0759</uri>
          <xref ref-type="aff" rid="A2">2</xref>
        </contrib>
        <contrib contrib-type="author" corresp="no">
          <name name-style="western">
            <surname>Dimitrov</surname>
            <given-names>Lyubomir</given-names>
          </name>
          <xref ref-type="aff" rid="A2">2</xref>
        </contrib>
        <contrib contrib-type="author" corresp="no">
          <name name-style="western">
            <surname>Kaneva</surname>
            <given-names>Anna</given-names>
          </name>
          <xref ref-type="aff" rid="A2">2</xref>
        </contrib>
        <contrib contrib-type="author" corresp="no">
          <name name-style="western">
            <surname>Lazarov</surname>
            <given-names>Stojan</given-names>
          </name>
          <xref ref-type="aff" rid="A2">2</xref>
        </contrib>
        <contrib contrib-type="author" corresp="no">
          <name name-style="western">
            <surname>Dobrev</surname>
            <given-names>Dobri</given-names>
          </name>
          <uri content-type="orcid">https://orcid.org/0000-0002-8493-1130</uri>
          <xref ref-type="aff" rid="A2">2</xref>
        </contrib>
        <contrib contrib-type="author" corresp="no">
          <name name-style="western">
            <surname>Gelev</surname>
            <given-names>Valeri</given-names>
          </name>
          <xref ref-type="aff" rid="A1">1</xref>
        </contrib>
      </contrib-group>
      <aff id="A1">
        <label>1</label>
        <addr-line content-type="verbatim">Acibadem City Clinic UMHAT Tokuda , Sofia, Bulgaria</addr-line>
        <institution>Acibadem City Clinic UMHAT Tokuda </institution>
        <addr-line content-type="city">Sofia</addr-line>
        <country>Bulgaria</country>
      </aff>
      <aff id="A2">
        <label>2</label>
        <addr-line content-type="verbatim">National Heart Hospital, Sofia, Bulgaria</addr-line>
        <institution>National Heart Hospital</institution>
        <addr-line content-type="city">Sofia</addr-line>
        <country>Bulgaria</country>
      </aff>
      <author-notes>
        <fn fn-type="corresp">
          <p>Corresponding author: Vassil Traykov (<email xlink:type="simple">vtraykov@yahoo.com</email>).</p>
        </fn>
        <fn fn-type="edited-by">
          <p>Academic editor: Krasimir Dzhinsov</p>
        </fn>
      </author-notes>
      <pub-date pub-type="collection">
        <year>2021</year>
      </pub-date>
      <pub-date pub-type="epub">
        <day>18</day>
        <month>10</month>
        <year>2021</year>
      </pub-date>
      <volume>27</volume>
      <issue>3</issue>
      <fpage>113</fpage>
      <lpage>122</lpage>
      <uri content-type="arpha" xlink:href="http://openbiodiv.net/A24D2539-757D-5E3A-BD60-AD0030FEC320">A24D2539-757D-5E3A-BD60-AD0030FEC320</uri>
      <uri content-type="zenodo_dep_id" xlink:href="https://zenodo.org/record/5598633">5598633</uri>
      <history>
        <date date-type="received">
          <day/>
          <month/>
          <year/>
        </date>
      </history>
      <permissions>
        <copyright-statement>Vassil Traykov, Tchavdar Shalganov, Lyubomir Dimitrov, Anna Kaneva, Stojan Lazarov, Dobri Dobrev, Valeri Gelev</copyright-statement>
        <license license-type="creative-commons-attribution" xlink:href="http://creativecommons.org/licenses/by/4.0/" xlink:type="simple">
          <license-p>This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p>
        </license>
      </permissions>
      <abstract>
        <label>Abstract</label>
        <p>We present the case of a 23-year-old male diagnosed with a complex congenital heart disease (with single ventricle physiology) which necessitated many surgical interventions including total cavopulmonary connection. The patient presents with recurrent (almost daily) highly symptomatic atrial tachycardia with rapid ventricular rate and poor haemodynamic tolerance. Due to failure of antiarrhythmic drug therapy the patient was referred for catheter ablation. Atrial access was provided following transconduit puncture with a standard transseptal set. Crossing to the atrium with the transseptal introducer was not successful due to resistance from the conduit and the atrial wall. Therefore, balloon dilation of the puncture using a cutting balloon was carried out which resulted in easy crossing to the atrium with a steerable transseptal introducer. Several atrial tachyarrhythmias were induced two of which allowed mapping demonstrating a macroreentrant tachycardia dependent on the cavoannular isthmus as well as a complex ﬁ gure-of-eight circuit involving right pulmonary veins and the right atrial appendage. Linear lesions transecting the critical isthmuses of the two circuits were delivered which rendered the patient noninducible. During a 9-month follow-up period the patient remained arrhythmia free.</p>
      </abstract>
    </article-meta>
  </front>
</article>
