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Capestro A, Soura E, Compagnucci P, Casella M, Marzullo R, Dello Russo A. Atrial Flutters in Adults with Congenital Heart Disease. Card Electrophysiol Clin 2022; 14:501-515. [PMID: 36153130 DOI: 10.1016/j.ccep.2022.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The macroreentrant atrial tachycardia is very frequent in the adults with congenital heart disease. The impact of the arrhythmias on this type of patients is related to several factors: the anatomy and physiopathology of the specific congenital heart disease (CHD), the sequelae of the corrective surgery or surgical palliation, the presence of residual lesions (shunt, regurgitation), and the age and the clinical status of the patient and the comorbidities. In turn, the mechanism of the MAT depends on the peculiar features of the conduction's system in the CHD and native and acquired (post-surgery) substrates.
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Affiliation(s)
- Alessandro Capestro
- Department of Paediatric and Congenital Cardiac Surgery and Cardiology, University Hospital "Ospedali Riuniti", via Conca 71, Ancona 60100, Italy.
| | - Elli Soura
- Department of Paediatric and Congenital Cardiac Surgery and Cardiology, University Hospital "Ospedali Riuniti", via Conca 71, Ancona 60100, Italy
| | - Paolo Compagnucci
- Cardiology And Arrhythmology Clinic, University Hospital "Ospedali Riuniti", via Conca 71, Ancona 60100, Italy; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, via Conca 71, Ancona 60100, Italy
| | - Michela Casella
- Cardiology And Arrhythmology Clinic, University Hospital "Ospedali Riuniti", via Conca 71, Ancona 60100, Italy; Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, via Conca 71, Ancona 60100, Italy
| | - Raffaella Marzullo
- Department of Pediatric Cardiology, University of Campania "Luigi Vanvitelli", Former Second University of Naples, "Monaldi Hospital-AORN Ospedale dei Colli", piazzale E Ruggieri, Naples 80131, Italy
| | - Antonio Dello Russo
- Cardiology And Arrhythmology Clinic, University Hospital "Ospedali Riuniti", via Conca 71, Ancona 60100, Italy; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, via Conca 71, Ancona 60100, Italy
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Chiriac A, Cheema KP, Giardi D, Espinosa SM, Fitzgerald P, Perez-Downes JC, Umadat G, Hodge DO, Phillips SD, Madhavan M, Asirvatham SJ, McLeod CJ. Atrial Arrhythmia Ablation in Patients With D-Transposition of the Great Arteries and Atrial Switch. Circ Arrhythm Electrophysiol 2022; 15:e010546. [PMID: 35763440 DOI: 10.1161/circep.121.010546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with D-transposition of the great arteries and atrial switch have a high incidence of atrial arrhythmias. We sought to analyze the arrhythmia substrate, ablation strategies, and outcomes for catheter ablation in this population. METHODS An in-depth analysis of all clinical and procedural data in patients with D-transposition of the great arteries, atrial baffles, and atrial arrhythmia ablation was performed. RESULTS A cohort of 32 patients (72% male, mean age 38±7 years) underwent ablation for non-AV nodal reentrant tachycardia atrial arrhythmias, and 4 patients underwent AV nodal reentrant tachycardia ablation. Cavotricuspid isthmus flutter (CTI-flutter) was the most common arrhythmia, encountered in 75% of patients, followed by scar-related intraatrial reentrant tachycardia (non-CTI intraatrial reentrant tachycardia, 53%) and focal atrial tachycardia (focal atrial tachycardia, 6%). Among the 32 patients, 26 underwent 31 procedures at our institution. For patients with prior outside intervention, the index ablation at our institution revealed CTI-dependent flutter in 3/5 cases. However, redo ablation after an index ablation with demonstrated bidirectional CTI block revealed different/new arrhythmia substrates (80% non-CTI intraatrial reentrant tachycardia, 40% focal atrial tachycardia). Achieving bidirectional block across the CTI often required ablating on both sides of the baffle (retroaortic access, 81%; using a baffle leak, 11.5%; or transbaffle puncture, 7.7%). Combined approaches were necessary in 19% to reach the critical tissue. Acute procedural success was 81%, and recurrence was documented in 58% of patients. Despite recurrence, clinical arrhythmia burden was significantly reduced post-ablation (P<0.001), with rare episodes, amenable to antiarrhythmic therapy. Redo ablation was required in 5 (19%) patients and uncovered new arrhythmia substrates. AV nodal reentrant tachycardia ablation also required transbaffle approaches in 3/4 patients. CONCLUSIONS CTI-dependent flutter was the most common arrhythmia in patients with Dextro-Transposition of the Great Arteries and atrial switch. Transbaffle approaches were often necessary, and, provided that bidirectional CTI block was achieved at the index ablation, late recurrence was due to different arrhythmia mechanisms. Despite recurrence, ablation was associated with significant clinical improvement.
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Affiliation(s)
- Anca Chiriac
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL. (A.C., K.P.C., D.G., S.M.E., J.C.P.-D., S.D.P., C.J.M.)
| | - Kamal P Cheema
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL. (A.C., K.P.C., D.G., S.M.E., J.C.P.-D., S.D.P., C.J.M.)
| | - Davide Giardi
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL. (A.C., K.P.C., D.G., S.M.E., J.C.P.-D., S.D.P., C.J.M.)
| | - Samantha M Espinosa
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL. (A.C., K.P.C., D.G., S.M.E., J.C.P.-D., S.D.P., C.J.M.)
| | - Patrick Fitzgerald
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL. (P.F., G.U.)
| | - Julio C Perez-Downes
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL. (A.C., K.P.C., D.G., S.M.E., J.C.P.-D., S.D.P., C.J.M.)
| | - Goyal Umadat
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL. (P.F., G.U.)
| | - David O Hodge
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL. (D.O.H.)
| | - Sabrina D Phillips
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL. (A.C., K.P.C., D.G., S.M.E., J.C.P.-D., S.D.P., C.J.M.)
| | - Malini Madhavan
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (M.M., S.J.A., C.J.M.)
| | - Samuel J Asirvatham
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (M.M., S.J.A., C.J.M.)
| | - Christopher J McLeod
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL. (A.C., K.P.C., D.G., S.M.E., J.C.P.-D., S.D.P., C.J.M.).,Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (M.M., S.J.A., C.J.M.)
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Palma A, Sousa PA, Silva PV, Pires A. Transbaffle Puncture Using Multimodality Imaging and 3-D Mapping with CT Image Integration in a Patient with Atrial Flutter Post-Senning Procedure. Arq Bras Cardiol 2021; 117:153-156. [PMID: 34320087 PMCID: PMC8294735 DOI: 10.36660/abc.20201267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 02/24/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Andreia Palma
- Departamento de Cardiologia Pediátrica , Centro de Referência de Cardiopatias Congénitas , Centro Hospitalar e Universitário de Coimbra , Coimbra - Portugal
| | - Pedro A Sousa
- Departamento de Cardiologia , Unidade de Pacing e Eletrofisiologia , Centro Hospitalar e Universitário de Coimbra , Coimbra - Portugal
| | - Patrícia V Silva
- Departamento de Cardiologia Pediátrica , Centro de Referência de Cardiopatias Congénitas , Centro Hospitalar e Universitário de Coimbra , Coimbra - Portugal
| | - António Pires
- Departamento de Cardiologia Pediátrica , Centro de Referência de Cardiopatias Congénitas , Centro Hospitalar e Universitário de Coimbra , Coimbra - Portugal
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Wasmer K, Eckardt L, Baumgartner H, Köbe J. Therapy of supraventricular and ventricular arrhythmias in adults with congenital heart disease-narrative review. Cardiovasc Diagn Ther 2021; 11:550-562. [PMID: 33968633 DOI: 10.21037/cdt-20-634] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Arrhythmias are among the most common late complications in adults with congenital heart disease (ACHD) and a frequent reason for hospital admission. Both, supraventricular and ventricular arrhythmias, not only cause debilitating symptoms, but may be life-threatening by increasing risk of stroke, causing or worsening heart failure and being associated with sudden death. Substrate and risk for arrhythmia differs widely between congenital defects with specific arrhythmias being much more common in some patients than others. Atrial macroreentrant arrhythmias are particularly frequent in patients with atrial septal defects and repair that involves atrial incisions including patients with transposition of the great arteries (TGA) and atrial switch. Accessory pathways and related arrhythmias are often associated with Ebstein's anomaly and congenitally corrected TGA. Monomorphic ventricular arrhythmias occur in patients with ventricular incisions, namely patients with Tetralogy of Fallot. Changes in surgical repair techniques influence arrhythmia prevalence and substrate as well as anatomical access for catheter ablation procedures. In addition, epidemiologic changes associated with improved long-term survival will further increase the prevalence of atrial fibrillation in ACHD. This article summarizes current understanding of prevalence of specific arrhythmias, underlying mechanisms, medical and interventional treatment options and their outcome in ACHD.
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Affiliation(s)
- Kristina Wasmer
- Department of Cardiology II - Electrophysiology, University Hospital Muenster, Cardiology, Muenster, Germany
| | - Lars Eckardt
- Department of Cardiology II - Electrophysiology, University Hospital Muenster, Cardiology, Muenster, Germany
| | - Helmut Baumgartner
- Department of Cardiology III, Division of Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Cardiology, Muenster, Germany
| | - Julia Köbe
- Department of Cardiology II - Electrophysiology, University Hospital Muenster, Cardiology, Muenster, Germany
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Abstract
The field of congenital cardiac electrophysiology is growing rapidly due to the rapid growth in the population of survivors of childhood critical congenital heart disease surgery. Chronic arrhythmias pose one of the biggest challenges in this patient population, and catheter ablation, despite its challenges, is still the most desirable and acceptable approach when successful. Clinicians who propose catheter ablation in such patients need to understand the congenital anatomy, should carefully review the details of all prior cardiac surgery, and should be prepared to deal with the various challenges posed by lack of normal cardiac access and the possibility of poor hemodynamics. Still, experienced laboratories can achieve excellent results in this difficult patient population.
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Affiliation(s)
- George F Van Hare
- Washington University School of Medicine, One Children's Place, Campus Box 8116, Saint Louis, MO 63110, USA.
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