Tetralogy of Fallot Going Too Fast

We present a case of a 36-year-old man with tetralogy of Fallot status post repair who developed wide complex tachycardia at a rate of 210 bpm during cardiopulmonary exercise tolerance test. During electrophysiology study, rapid atrial stimulation induced sustained atrial flutter with an atrial cycle length of 240 ms. Atrial flutter was successfully eliminated by creating a complete line of block between the tricuspid annulus and the Eustachian ridge.