Ebstein’s Anomaly: How to Identify Intracardiac Structures When Electrical Signals Do Not Match the Anatomy

In patients with Ebstein’s anomaly, the distorted anatomy with discordance between the true atrioventricular (AV) groove and the tricuspid valve poses many challenges to the electrophysiologist. Intracardiac echocardiography is a recent tool that allows visualization of the displaced tricuspid valve, the true AV groove, and the atrialized right ventricle. We present a 3-dimensional electroanatomic map built using intracardiac echocardiography and the CARTOSOUND(®) module (Biosense Webster, Diamond Bar, CA, USA) in one such patient who underwent ablation of a right-sided mid-septal accessory pathway.