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Zhang J. High density mapping of atrial tachycardia in patients post cardiac surgery. Pacing Clin Electrophysiol 2023; 46:1357-1365. [PMID: 37910563 DOI: 10.1111/pace.14858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 10/08/2023] [Accepted: 10/15/2023] [Indexed: 11/03/2023]
Abstract
Mapping and ablation of atrial tachycardia (AT) in patients who have had prior cardiac surgery can be a challenge for clinical electrophysiologists. High density mapping (HDM) technology has been widely used in these patients because it provides a better characterization of the substrate and the mechanisms with an unprecedented high resolution. In this review, we summarize how the latest HDM technologies can reveal the mechanism of AT in different types of patients post-cardiac surgery and guide a specifically tailored ablation strategy.
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Affiliation(s)
- Jinlin Zhang
- Department of Cardiology, Wuhan Asian Heart Hospital, Wuhan, China
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2
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Taguchi Y, Matsumoto K, Shoda M, Nitta M, Hosoda J, Ishikawa T. A case of successful catheter ablation for biatrial reentrant tachycardia after a Mustard operation for dextro-transposition of the great arteries. HeartRhythm Case Rep 2022; 9:140-143. [PMID: 36970393 PMCID: PMC10030292 DOI: 10.1016/j.hrcr.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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3
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Marazzato J, Marazzi R, Doni LA, Angeli F, Bagliani G, Leonelli FM, De Ponti R. Mapping and Ablation of Atypical Atrial Flutters. Card Electrophysiol Clin 2022; 14:471-481. [PMID: 36153127 DOI: 10.1016/j.ccep.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Atypical atrial flutters are complex, hard-to-manage atrial arrhythmias. Catheter ablation has progressively emerged as a successful treatment option with a remarkable role played by irrigated-tip catheters and 3D electroanatomic mapping systems. However, despite the improvement of these technologies, the ablation results may be still suboptimal due to the progressive atrial substrate modification occurring in diseased hearts. Hence, a patient-tailored approach is required to improve the long-term success rate in this scenario, aiming at achieving specific procedure end points and detecting any potential arrhythmogenic substrate in each patient.
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Affiliation(s)
- Jacopo Marazzato
- Department of Heart and Vessels, Ospedale di Circolo - University of Insubria, Viale Borri, 57, Varese 21100, Italy; Department of Medicine and Surgery, University of Insubria, Viale Guicciardini, 9, Varese 21100, Italy
| | - Raffaella Marazzi
- Department of Heart and Vessels, Ospedale di Circolo - University of Insubria, Viale Borri, 57, Varese 21100, Italy
| | - Lorenzo A Doni
- Department of Heart and Vessels, Ospedale di Circolo - University of Insubria, Viale Borri, 57, Varese 21100, Italy
| | - Fabio Angeli
- Department of Medicine and Surgery, University of Insubria, Viale Guicciardini, 9, Varese 21100, Italy; Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS, Via Crotto Roncacci, 16, Tradate, Varese 21049, Italy
| | - Giuseppe Bagliani
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti Umberto I-Lancisi-Salesi", Via Conca 71, Ancona 60126, Italy
| | - Fabio M Leonelli
- Cardiology Department, James A. Haley Veterans' Hospital, University of South Florida, 13000 Bruce B Down Boulevard, Tampa, FL 33612, USA
| | - Roberto De Ponti
- Department of Heart and Vessels, Ospedale di Circolo - University of Insubria, Viale Borri, 57, Varese 21100, Italy; Department of Medicine and Surgery, University of Insubria, Viale Guicciardini, 9, Varese 21100, Italy.
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4
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De Ponti R, Marazzi R, Vilotta M, Angeli F, Marazzato J. Procedural Feasibility and Long-Term Efficacy of Catheter Ablation of Atypical Atrial Flutters in a Wide Spectrum of Heart Diseases: An Updated Clinical Overview. J Clin Med 2022; 11:jcm11123323. [PMID: 35743394 PMCID: PMC9224569 DOI: 10.3390/jcm11123323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 06/02/2022] [Accepted: 06/08/2022] [Indexed: 02/01/2023] Open
Abstract
Atypical atrial flutters (AAFL) are difficult-to-manage atrial arrhythmias, yet potentially amenable to effective radiofrequency catheter ablation (CA). However, data on CA feasibility are only sparingly reported in the literature in different clinical settings, such as AAFL related to surgical correction of congenital heart disease. The aim of this review was to provide an overview of the clinical settings in which AAFL may occur to help the cardiac electrophysiologist in the prediction of the tachycardia circuit location before CA. Moreover, the role and proper implementation of cutting-edge technologies in this setting were investigated as well as which procedural and clinical factors are associated with long-term failure to maintain sinus rhythm (SR) to find out which patients may, or may not, benefit from this procedure. Not only different surgical and non-surgical scenarios are associated with peculiar anatomical location of AAFL, but we also found that CA of AAFL is generally feasible. The success rate may be as low as 50% in surgically corrected congenital heart disease (CHD) patients but up to about 90% on average after pulmonary vein isolation (PVI) or in patients without structural heart disease. Over the years, the progressive implementation of three-dimensional mapping systems and high-density mapping tools has also proved helpful for ablation of these macro-reentrant circuits. However, the long-term maintenance of SR may still be suboptimal due to the progressive electroanatomic atrial remodeling occurring after cardiac surgery or other interventional procedures, thus limiting the likelihood of successful ablation in specific clinical settings.
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Affiliation(s)
- Roberto De Ponti
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy;
- Department of Heart and Vessels, Ospedale di Circolo, 21100 Varese, Italy; (R.M.); (M.V.)
- Correspondence:
| | - Raffaella Marazzi
- Department of Heart and Vessels, Ospedale di Circolo, 21100 Varese, Italy; (R.M.); (M.V.)
| | - Manola Vilotta
- Department of Heart and Vessels, Ospedale di Circolo, 21100 Varese, Italy; (R.M.); (M.V.)
| | - Fabio Angeli
- Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS Tradate, 21049 Tradate, Italy;
| | - Jacopo Marazzato
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy;
- Department of Heart and Vessels, Ospedale di Circolo, 21100 Varese, Italy; (R.M.); (M.V.)
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5
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Brugada J, Katritsis DG, Arbelo E, Arribas F, Bax JJ, Blomström-Lundqvist C, Calkins H, Corrado D, Deftereos SG, Diller GP, Gomez-Doblas JJ, Gorenek B, Grace A, Ho SY, Kaski JC, Kuck KH, Lambiase PD, Sacher F, Sarquella-Brugada G, Suwalski P, Zaza A. 2019 ESC Guidelines for the management of patients with supraventricular tachycardiaThe Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC). Eur Heart J 2021; 41:655-720. [PMID: 31504425 DOI: 10.1093/eurheartj/ehz467] [Citation(s) in RCA: 522] [Impact Index Per Article: 174.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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6
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Extensive scar modification for the treatment of intra-atrial re-entrant tachycardia in patients after congenital heart surgery. Cardiol Young 2020; 30:1231-1237. [PMID: 32698928 DOI: 10.1017/s1047951120001900] [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: 11/07/2022]
Abstract
BACKGROUND Catheter ablation is an important therapeutic option for atrial tachycardias in patients with CHD. As a result of extensive scarring and surgical repair, multiple intra-atrial re-entrant tachycardia circuits develop and serve as a substrate for arrhythmias. The best ablation approach for patients with multiple intra-atrial re-entrant tachycardias has not been investigated. Here, we compared substrate-based ablation using extensive scar modification to conventional ablation. METHODS The present study included patients with surgically corrected CHD that underwent intra-atrial re-entrant tachycardia ablation. Extensive scar modification was defined as substrate ablation based on a dense voltage map, aimed to eliminate all potentials in the scar region. The control group had activation mapping-based ablation. A clinical composite endpoint was assessed. Points were given for type, number, and treatment of intra-atrial re-entrant tachycardia recurrence. RESULTS In 40 patients, 63 (extensive scar modification 13) procedures were performed. Acute procedural success was achieved in 78%. Procedural duration was similar in both groups. Forty-nine percent had a recurrence within 1 year. During a 5-year follow-up (2.5-7.5 years), 46% required repeat catheter ablation. Compared to baseline, clinical composite endpoint significantly decreased by 46% after 12 months (p = 0.001). Acute procedural success, procedural parameters, recurrence and repeat ablation were similar between extensive scar modification and activation mapping-based ablation. CONCLUSION Catheter ablation using extensive scar modification for intra-atrial re-entrant tachycardias occurring after surgically corrected CHD illustrated similar short- and long-term outcomes and procedural efficiency compared to catheter ablation using activation mapping-based ablation. The choice of ablation approach for multiple intra-atrial re-entrant tachycardia should remain at the discretion of the operator.
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Abstract
Arrhythmia management in adult congenital heart disease (ACHD) encompasses a wide range of problems from bradyarrhythmia to tachyarrhythmia, sudden death, and heart failure-related electrical dyssynchrony. Major advances in the understanding of the pathophysiology and treatments of these problems over the past decade have resulted in improved therapeutic strategies and outcomes. This article attempts to define these problems and review contemporary management for the patient with ACHD presenting with cardiac arrhythmia.
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Affiliation(s)
- Jeremy P Moore
- Ahmanson-UCLA/Adult Congenital Heart Disease Center, Los Angeles, CA, USA; Department of Pediatrics, UCLA Medical Center, Los Angeles, CA, USA.
| | - Paul Khairy
- Electrophysiology Service and Adult Congenital Heart Disease Center; Department of Medicine, Montreal Heart Institute, Université de Montréal, 5000 Bélanger Street, Montreal, Quebec H1T 1C8, Canada
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Pathik B, Kalman JM. Perceiving the Imperceptible in Atrial Macro-Reentry: Ultrahigh Resolution Mapping to Characterize the Critical Isthmus. Circ Arrhythm Electrophysiol 2018; 10:CIRCEP.116.004850. [PMID: 28039283 DOI: 10.1161/circep.116.004850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Bhupesh Pathik
- From the Department of Cardiology, Royal Melbourne Hospital & Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Australia
| | - Jonathan M Kalman
- From the Department of Cardiology, Royal Melbourne Hospital & Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Australia.
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9
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Katritsis DG, Boriani G, Cosio FG, Hindricks G, Jaïs P, Josephson ME, Keegan R, Kim YH, Knight BP, Kuck KH, Lane DA, Lip GYH, Malmborg H, Oral H, Pappone C, Themistoclakis S, Wood KA, Blomström-Lundqvist C, Gorenek B, Dagres N, Dan GA, Vos MA, Kudaiberdieva G, Crijns H, Roberts-Thomson K, Lin YJ, Vanegas D, Caorsi WR, Cronin E, Rickard J. European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardiaca y Electrofisiologia (SOLAECE). Europace 2018; 19:465-511. [PMID: 27856540 DOI: 10.1093/europace/euw301] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Demosthenes G Katritsis
- Athens Euroclinic, Athens, Greece; and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Giuseppe Boriani
- Cardiology Department, Modena University Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Pierre Jaïs
- University of Bordeaux, CHU Bordeaux, LIRYC, France
| | | | - Roberto Keegan
- Hospital Privado del Sur y Hospital Español, Bahia Blanca, Argentina
| | - Young-Hoon Kim
- Korea University Medical Center, Seoul, Republic of Korea
| | | | | | - Deirdre A Lane
- Asklepios Hospital St Georg, Hamburg, Germany.,University of Birmingham Institute of Cardiovascular Science, City Hospital, Birmingham, UK; and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Gregory Y H Lip
- University of Birmingham Institute of Cardiovascular Science, City Hospital, Birmingham, UK; and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Helena Malmborg
- Department of Cardiology and Medical Science, Uppsala University, Uppsala, Sweden
| | - Hakan Oral
- University of Michigan, Ann Arbor, MI, USA
| | - Carlo Pappone
- IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | | | | | - Bulent Gorenek
- Cardiology Department, Eskisehir Osmangazi University, Eskisehir, Turkey
| | | | - Gheorge-Andrei Dan
- Colentina University Hospital, 'Carol Davila' University of Medicine, Bucharest, Romania
| | - Marc A Vos
- Department of Medical Physiology, Division Heart and Lungs, Umc Utrecht, The Netherlands
| | | | - Harry Crijns
- Mastricht University Medical Centre, Cardiology & CARIM, The Netherlands
| | | | | | - Diego Vanegas
- Hospital Militar Central - Unidad de Electrofisiologìa - FUNDARRITMIA, Bogotà, Colombia
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10
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Entrainment and high-density three-dimensional mapping in right atrial macroreentry provide critical complementary information: Entrainment may unmask “visual reentry” as passive. Heart Rhythm 2017. [DOI: 10.1016/j.hrthm.2017.06.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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11
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Lundqvist CB, Potpara TS, Malmborg H. Supraventricular Arrhythmias in Patients with Adult Congenital Heart Disease. Arrhythm Electrophysiol Rev 2017; 6:42-49. [PMID: 28835834 PMCID: PMC5517371 DOI: 10.15420/aer.2016:29:3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 10/20/2016] [Indexed: 12/18/2022] Open
Abstract
An increasing number of patients with congenital heart disease survive to adulthood; such prolonged survival is related to a rapid evolution of successful surgical repairs and modern diagnostic techniques. Despite these improvements, corrective atrial incisions performed at surgery still lead to subsequent myocardial scarring harbouring a potential substrate for macro-reentrant atrial tachycardia. Macroreentrant atrial tachycardias are the most common (75 %) type of supraventricular tachycardia (SVT) in patients with adult congenital heart disease (ACHD). Patients with ACHD, atrial tachycardias and impaired ventricular function - important risk factors for sudden cardiac death (SCD) - have a 2-9 % SCD risk per decade. Moreover, ACHD imposes certain considerations when choosing antiarrhythmic drugs from a safety aspect and also when considering catheter ablation procedures related to the inherent cardiac anatomical barriers and required expertise. Expert recommendations for physicians managing these patients are therefore mandatory. This review summarises current evidence-based developments in the field, focusing on advances in and general recommendations for the management of ACHD, including the recently published recommendations on management of SVT by the European Heart Rhythm Association.
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Affiliation(s)
| | - Tatjana S Potpara
- School of Medicine, University of Belgrade, Serbia; Cardiology Clinic, Clinical Center of Serbia.
| | - Helena Malmborg
- Institution of Medical Science, Uppsala University, Uppsala, Sweden
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12
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Baysa SJ, Olen M, Kanter RJ. Arrhythmias Following the Mustard and Senning Operations for Dextro-Transposition of the Great Arteries: Clinical Aspects and Catheter Ablation. Card Electrophysiol Clin 2017; 9:255-271. [PMID: 28457240 DOI: 10.1016/j.ccep.2017.02.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The atrial switch operations, the Mustard and Senning procedures, performed for dextro-transposition of the great arteries, have largely been supplanted by the arterial switch operation. As such, affected patients will only exist for approximately 30 more years. The main arrhythmias in these patients include sinoatrial node dysfunction, intraatrial reentry tachycardia, and sudden death. Device therapy for these patients is well-established, and catheter ablation for atrial tachycardias is highly efficacious. The application of meticulous procedural planning, customization of catheter courses, and electrophysiologic principles to this patient group may be extended to all postoperative complex congenital heart patients.
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Affiliation(s)
- Sherrie Joy Baysa
- Division of Cardiology, Nicklaus Children's Hospital, Miami, FL 33155, USA
| | - Melissa Olen
- Division of Cardiology, Nicklaus Children's Hospital, Miami, FL 33155, USA
| | - Ronald J Kanter
- Division of Cardiology, Nicklaus Children's Hospital, Miami, FL 33155, USA.
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13
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Hluchy J, Nguyen DQ, Sobczak H, Brandts B. Nonfluoroscopic Imaging as Guidance for Radiofrequency Ablation of Atrioventricular Nodal Reentrant Tachycardia after Mustard Repair. Tex Heart Inst J 2017; 44:58-61. [PMID: 28265215 DOI: 10.14503/thij-15-5548] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Most tachycardias in the pulmonary venous atrium are inaccessible by direct means and require either a retrograde approach or a transseptal approach for ablation. We present a case in which successful radiofrequency ablation of common atrioventricular nodal reentrant tachycardia was accomplished via a retrograde transaortic approach guided by nonfluoroscopic mapping with use of the NavX™ mapping system. The patient was a 49-year-old woman who at the age of 4 years had undergone Mustard repair for complete dextrotransposition of the great arteries. Three-dimensional reconstructions of the ascending aorta, right ventricle, systemic venous atrium, left ventricle, and superior vena cava-inferior vena cava baffle complex were created, and the left-sided His bundle was marked. After a failed attempt at ablation from the systemic venous side, we eliminated the atrioventricular nodal reentrant tachycardia by ablation from the pulmonary venous side. This case is, to our knowledge, the first report of successful radiofrequency ablation of common atrioventricular nodal reentrant tachycardia after Mustard repair for this congenital cardiac malformation in which ablation was guided by 3-dimensional nonfluoroscopic imaging. This imaging technique enabled accurate anatomic location of the ablation catheters in relation to the His bundle marked from the systemic venous side.
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14
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Gallotti RG, Madnawat H, Shannon KM, Aboulhosn JA, Nik-Ahd F, Moore JP. Mechanisms and predictors of recurrent tachycardia after catheter ablation for d-transposition of the great arteries after the Mustard or Senning operation. Heart Rhythm 2017; 14:350-356. [DOI: 10.1016/j.hrthm.2016.11.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Indexed: 11/25/2022]
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15
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Atrial tachyarrhythmias after atrial switch operation for transposition of the great arteries: Treating old surgery with new catheters. Heart Rhythm 2016; 13:1731-8. [DOI: 10.1016/j.hrthm.2016.03.046] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Indexed: 11/18/2022]
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16
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Zambito MP, Samuel BP, Vettukattil JJ, Ratnasamy C. Fluoroless catheter ablation of intraatrial reentrant tachycardia status post Fontan procedure: Fluoroless catheter ablation in Fontan patient. Int J Cardiol 2015; 201:126-8. [PMID: 26298353 DOI: 10.1016/j.ijcard.2015.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 08/01/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Mario P Zambito
- College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Bennett P Samuel
- Congenital Heart Center, Helen DeVos Children's Hospital of Spectrum Health, Grand Rapids, MI, USA
| | - Joseph J Vettukattil
- Congenital Heart Center, Helen DeVos Children's Hospital of Spectrum Health, Grand Rapids, MI, USA
| | - Christopher Ratnasamy
- Congenital Heart Center, Helen DeVos Children's Hospital of Spectrum Health, Grand Rapids, MI, USA.
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18
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Radiofrequency catheter ablation of atrial tachyarrhythmias after an atrial switch operation in a patient with univentricular heart combined with transposition of the great arteries. Cardiol Young 2015; 25:1224-7. [PMID: 25275370 DOI: 10.1017/s1047951114001851] [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: 11/06/2022]
Abstract
A 31-year-old patient previously underwent a Mustard operation presented with palpitations. Atrial tachycardia and paroxysmal atrial fibrillation were documented on the surface electrocardiogram. Under the guidance of a three-dimensional electroanatomic mapping system, ablation of the isolated left-sided pulmonary vein and a cavo-tricuspid isthmus-dependent intra-atrial macro re-entry circuit eliminated atrial tachycardia and paroxysmal atrial fibrillation without the recurrence of atrial tachyarrhythmia.
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19
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Yoshida N, Yamada T. Pseudo typical atrial flutter occurring after cavotricuspid isthmus ablation in a patient with a prior history of Senning operation. HeartRhythm Case Rep 2015; 1:54-57. [PMID: 28491511 PMCID: PMC5418534 DOI: 10.1016/j.hrcr.2014.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | - Takumi Yamada
- Address reprint requests and correspondence: Dr Takumi Yamada, Division of Cardiovascular Disease, University of Alabama at Birmingham, FOT 930A, 510 20th St S, 1530 3rd Avenue S, Birmingham, AL 35294
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20
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Koyak Z, de Groot JR, Mulder BJM. Interventional and surgical treatment of cardiac arrhythmias in adults with congenital heart disease. Expert Rev Cardiovasc Ther 2014; 8:1753-66. [DOI: 10.1586/erc.10.152] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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21
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Wu J, Deisenhofer I, Ammar S, Fichtner S, Reents T, Zhu P, Jilek C, Kolb C, Hess J, Hessling G. Acute and long-term outcome after catheter ablation of supraventricular tachycardia in patients after the Mustard or Senning operation for D-transposition of the great arteries. ACTA ACUST UNITED AC 2013; 15:886-91. [DOI: 10.1093/europace/eus402] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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22
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ALMENDRAL JESÚS. Resetting and Entrainment of Reentrant Arrhythmias: Part II: Informative Content and Practical Use of These Responses. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 36:641-61. [DOI: 10.1111/pace.12075] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Accepted: 11/24/2012] [Indexed: 11/27/2022]
Affiliation(s)
- JESÚS ALMENDRAL
- From the Cardiac Arrhythmia Unit; Grupo Hospital de Madrid; Universidad CEU-San Pablo; Madrid; Spain
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23
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Radbill AE, Fish FA. Mapping and ablation of supraventricular tachycardia in pediatric and congenital heart disease patients. PROGRESS IN PEDIATRIC CARDIOLOGY 2013. [DOI: 10.1016/j.ppedcard.2012.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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24
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Pflaumer A, Chard R, Davis AM. Perspectives in Interventional Electrophysiology in Children and those with Congenital Heart Disease. Heart Lung Circ 2012; 21:413-20. [DOI: 10.1016/j.hlc.2012.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2012] [Revised: 04/02/2012] [Accepted: 04/02/2012] [Indexed: 10/28/2022]
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25
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Ernst S, Babu-Narayan SV, Keegan J, Horduna I, Lyne J, Till J, Kilner PJ, Pennell D, Rigby ML, Gatzoulis MA. Remote-Controlled Magnetic Navigation and Ablation With 3D Image Integration as an Alternative Approach in Patients With Intra-Atrial Baffle Anatomy. Circ Arrhythm Electrophysiol 2012; 5:131-9. [DOI: 10.1161/circep.111.962993] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Sabine Ernst
- From the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, United Kingdom
| | - Sonya V. Babu-Narayan
- From the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, United Kingdom
| | - Jennifer Keegan
- From the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, United Kingdom
| | - Irina Horduna
- From the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, United Kingdom
| | - Jonathan Lyne
- From the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, United Kingdom
| | - Janice Till
- From the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, United Kingdom
| | - Philip J. Kilner
- From the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, United Kingdom
| | - Dudley Pennell
- From the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, United Kingdom
| | - Michael L. Rigby
- From the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, United Kingdom
| | - Michael A. Gatzoulis
- From the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, United Kingdom
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Outcome of intra-atrial re-entrant tachycardia catheter ablation in adults with congenital heart disease: negative impact of age and complex atrial surgery. J Am Coll Cardiol 2010; 56:1589-96. [PMID: 21029876 DOI: 10.1016/j.jacc.2010.04.061] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Revised: 03/12/2010] [Accepted: 04/06/2010] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The aim of this study was to determine the acute and long-term outcome of radiofrequency catheter ablation (RFCA) for intra-atrial re-entrant tachycardia (IART) in adults with congenital heart disease (CHD), and predictors of these outcomes. BACKGROUND Atrial myopathy can be progressive in CHD and contributes to the substrate for IART. Although the outcome of RFCA for IART has been well described in children and adolescents with CHD, it is unclear whether these results are similar in the adult population. METHODS Clinical records of adults with CHD undergoing attempted RFCA of IART were analyzed retrospectively. Multivariate analyses identified clinical and procedural factors that predicted acute and long-term outcomes. RESULTS A total of 193 procedures was performed in 130 patients (mean age 40 ± 13 years); 82 of 118 (69%) initially attempted RFCA were successful, defined as termination of all IART circuits. The use of electroanatomic mapping was associated with a successful RFCA, whereas Fontan palliation and Mustard repair were associated with an unsuccessful RFCA. Median clinical follow-up of 77 patients (≥2 months of follow-up) after a successful RFCA was 3.7 years (range 0.2 to 10.2 years). IART recurrence was noted in 48%, cardioversion/reablation in 42%, and death in 4%. Older age and Fontan palliation were independent predictors of IART recurrence. CONCLUSIONS In adults with CHD, acute and long-term outcomes of RFCA for IART are similar to those reported for younger cohorts. Complex atrial surgery limits the success of RFCA, and older age is associated with a higher risk of IART recurrence.
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Johnson C, Lee R. Ablation of Atrial Flutter in Congenital Heart Disease. Card Electrophysiol Clin 2010; 2:305-308. [PMID: 28770770 DOI: 10.1016/j.ccep.2010.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A 42-year-old woman with a history of D-transposition of the great arteries and a Mustard correction at age 5 years presented to an outside hospital with palpitations and chest pain. The electrophysiology study and strategy for radiofrequency ablation are discussed.
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Affiliation(s)
- Colleen Johnson
- Division of Cardiology, Cardiac Electrophysiology Department, University of California San Francisco, 500 Parnassus Avenue, MU 434, Box 1354, San Francisco, CA 94143, USA
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28
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Wu J, Pflaumer A, Deisenhofer I, Hoppmann P, Hess J, Hessling G. Mapping of atrial tachycardia by remote magnetic navigation in postoperative patients with congenital heart disease. J Cardiovasc Electrophysiol 2010; 21:751-9. [PMID: 20132396 DOI: 10.1111/j.1540-8167.2009.01697.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate if remote magnetic navigation (RMN) offers a reduction of fluoroscopy time when used for atrial tachycardia (AT) mapping in a spectrum of patients with congenital heart disease (CHD) after "simple" or "complex" atrial surgery. BACKGROUND Data about AT mapping using RMN in larger populations of patients with CHD are scarce. METHODS RMN in combination with electroanatomic mapping was used for AT mapping in 22 patients. According to anatomic complexity, patients were classified into 3 groups: Group 1: patients after minor atrial surgery (n = 7); Group 2: patients after the Fontan operation (n = 9); and group 3: patients after the Senning/Mustard operation (n = 6). RESULTS Atrial mapping with a nonirrigated tip RMN catheter was completed successfully in all patients. In Group 1 no significant reduction in fluoroscopy time was noticed over time (mean fluoroscopy time 7.9 minutes). In the 15 patients of group 2 and group 3 with complex CHD, the fluoroscopy time for mapping in the last 9 patients (6.4 +/- 2.8 minutes) was significantly shorter than in the first 6 patients (29.7 +/- 10.5 minutes, P < 0.0001). Acutely successful ablation was achieved in 21 of 22 patients (97%) using the RMN catheter (n = 3) or a conventional catheter (n = 18) without procedural complications. CONCLUSIONS RMN for AT mapping in patients with complex atrial anatomy leads to a significant reduction of fluoroscopy time.
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Affiliation(s)
- Jinjin Wu
- Deutsches Herzzentrum München, Munich, Germany.
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29
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den Uijl DW, Blom NA, Wijnmaalen AP, Bax JJ, Schalij MJ, Zeppenfeld K. Real-time integration of intracardiac echocardiography to facilitate atrial tachycardia ablation in a patient with a Senning baffle. Circ Arrhythm Electrophysiol 2009; 2:e28-30. [PMID: 19843911 DOI: 10.1161/circep.109.875534] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Dennis W den Uijl
- Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
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30
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BALAJI SESHADRI, STAJDUHAR KARLC, ZARRAGA IGNATIUSG, KRON JACK. Simplified Demonstration of Cavotricuspid Isthmus Block After Catheter Ablation in Patients After Mustard's Operation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:1294-8. [DOI: 10.1111/j.1540-8159.2009.02491.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Peichl P, Kautzner J, Gebauer R. Ablation of atrial tachycardias after correction of complex congenital heart diseases: utility of intracardiac echocardiography. Europace 2008; 11:48-53. [DOI: 10.1093/europace/eun316] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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32
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WU JINJIN, PFLAUMER ANDREAS, DEISENHOFER ISABEL, ÜCER EKREM, HESS JOHN, ZRENNER BERNHARD, HESSLING GABRIELE. Mapping of Intraatrial Reentrant Tachycardias by Remote Magnetic Navigation in Patients with d-Transposition of the Great Arteries After Mustard or Senning Procedure. J Cardiovasc Electrophysiol 2008; 19:1153-9. [DOI: 10.1111/j.1540-8167.2008.01231.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Aryana A, Liberthson RR, Heist EK, d'Avila A, Mandapati R, Cury RC, Ruskin JN, Mansour MC. Ablation of Atrial Flutter in a Patient With Mustard Procedure Using Integration of Real-Time Electroanatomical Mapping With 3-Dimensional Computed Tomographic Imaging. Circulation 2007; 116:e315-6. [PMID: 17724267 DOI: 10.1161/circulationaha.107.716795] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Arash Aryana
- Cardiac Arrhythmia Service, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
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McDaniel GM, Van Hare GF. Catheter ablation in children and adolescents. Heart Rhythm 2006; 3:95-101. [PMID: 16399063 DOI: 10.1016/j.hrthm.2005.09.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2005] [Accepted: 09/29/2005] [Indexed: 11/27/2022]
Abstract
Adult and pediatric interventional electrophysiology practices have been diverging for the past 10 years, and so we review current pediatric ablation practice. Radiofrequency ablation (RFA) is safe and efficacious as documented by recent prospective, multi-center pediatric studies. Computer assisted mapping systems used for complex arrhythmias in adult patients have been successfully deployed in selected pediatric substrates. With increased computational power, decreased catheter size, and increased maneuverability, we expect increased use in the pediatric population. Finally, cryoablation has demonstrated efficacy and safety in locations traditionally associated with increased risk when using RFA, particularly around the AV node. As larger, multi-institutional studies are undertaken, the benefits of this technology in pediatric patients will be better defined.
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Affiliation(s)
- George M McDaniel
- Congenital Heart Institute of Florida, St. Petersburg, Florida 33701, USA.
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Abstract
There is a large group of young adults who survived atrial baffle repair of transposition of the great arteries. Most survivors are asymptomatic, although nearly all have decreased exercise capacity. Loss of sinus rhythm and atrial arrhythmias are common and increase with age. There is concern about the ability of the right ventricle to function long term as a systemic pump, and recent publications have highlighted right ventricular dysfunction in this patient population. Sudden death and congestive heart failure are the main causes of death, and outcomes beyond 30 years are unknown. Pulmonary artery banding, late arterial switch, and cardiac transplantation are employed when intractable arrhythmias or right ventricular failure threaten survival or quality of life.
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Affiliation(s)
- Daniel J Murphy
- Stanford University Medical Center, Palo Alto, CA 94304, USA.
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Abstract
PURPOSE OF REVIEW Intraatrial reentrant tachycardia (IART), a difficult arrhythmia to manage, is likely to become more prevalent as the population of patients with congenital heart disease grows. While pharmacologic therapy alone often remains inadequate, important advances in nonpharmacologic therapy have occurred recently, enhancing the currently available therapeutic options. This review focuses on advances in electroanatomic mapping and catheter ablation, developments in arrhythmia surgery, and device therapy for IART. RECENT FINDINGS While catheter ablation for IART has high early recurrence rates, the lack of late recurrence in long-term follow-up is encouraging. Acute success may be improved with greater appreciation for reentrant circuits with current electroanatomic mapping systems, and with larger lesions that can be achieved with the use of irrigated-tip catheters. Arrhythmia surgery at the time of Fontan revision has good short-term and medium-term results, and is being studied as a prophylactic measure at initial Fontan surgery. Device therapy for IART now includes algorithms to prevent atrial arrhythmias, as well as antitachycardia pacing, which can be used safely and has very high efficacy for certain subgroups. SUMMARY Due to recent advances in mapping and ablation technology, coupled with developments in arrhythmia surgery and device therapy, the armamentarium of nonpharmacologic management of IART has become more potent. There are still, however, unique challenges posed by patients with congenital heart disease, and long-term follow-up in large numbers of patients with IART are required for this expanding population of patients.
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Affiliation(s)
- Prince J Kannankeril
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2572, USA
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Lukac P, Pedersen AK, Mortensen PT, Jensen HK, Hjortdal V, Hansen PS. Ablation of atrial tachycardia after surgery for congenital and acquired heart disease using an electroanatomic mapping system: Which circuits to expect in which substrate? Heart Rhythm 2005; 2:64-72. [PMID: 15851267 DOI: 10.1016/j.hrthm.2004.10.034] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2004] [Accepted: 10/20/2004] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The purpose of this study was to compare atrial tachycardia circuits after a range of cardiac operations. BACKGROUND Knowledge of circuits occurring in a given postsurgical substrate should help to ablate these challenging tachycardias and develop potential preventive strategies. METHODS We analyzed tachycardia circuits in 83 consecutive patients (60 males; median age 47 years, range 9-73) after atrial incisions undergoing ablation of atrial tachycardias. A combined strategy of electroanatomic (CARTO) and entrainment mapping was used. Fifty-two patients (63%) underwent operation for congenital and 31 (37%) for acquired heart disease. Patients were divided into subgroups based on the intervention performed in the atria: right lateral atriotomy (39 patients), left atrial (11) and superior transseptal (10) approach to the mitral valve, biatrial heart transplantation (8), Mustard (8) and Fontan (4) procedure, and other interventions (3). RESULTS Most of the 119 tachycardias mapped were isthmus-dependent atrial flutter (66) and incisional tachycardia (30). Isthmus-dependent atrial flutter was the most frequent arrhythmia in all subgroups except for Fontan patients, in whom incisional tachycardia was most frequent. The distribution of tachycardia circuits did not differ significantly among groups. CONCLUSIONS The observed circuits did not differ among the postsurgical substrates. Isthmus-dependent atrial flutter should be the first circuit considered in patients after atrial incisions.
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Affiliation(s)
- Peter Lukac
- Department of Cardiology, Aarhus University Hospital at Skejby, Denmark.
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Deisenhofer I, Estner H, Pflaumer A, Zrenner B. Atypical access to typical atrial flutter. Heart Rhythm 2005; 2:93-6. [PMID: 15851272 DOI: 10.1016/j.hrthm.2004.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2004] [Accepted: 09/04/2004] [Indexed: 10/25/2022]
Abstract
Typical atrial flutter with reentry around the tricuspid valve can easily be cured by ablating the cavotricuspid isthmus. In the reported case, transvenous access to the tricuspid valve was not possible because of a total cavopulmonal connection in congenital mitral atresia. Successful angioplasty of a small fenestration between the total cavopulmonal connection and the genuine right atrium (RA) allowed anterograde transvenous access to the RA. Electroanatomic RA mapping confirmed peritricuspid reentry, and successful ablation was performed.
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Affiliation(s)
- Isabel Deisenhofer
- Department of Cardio-Vascular Disease, Deutsches Herzzentrum München, Technische Universität München, Germany.
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Chun TUH, Van Hare GF. Advances in the approach to treatment of supraventricular tachycardia in the pediatric population. Curr Cardiol Rep 2004; 6:322-6. [PMID: 15306087 DOI: 10.1007/s11886-004-0033-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Supraventricular tachycardia is relatively common in children. Although most forms are not life threatening, treatment options depend on appropriate diagnosis. In certain patients, medical treatments are adequate for controlling symptoms. For those in whom medical therapy is inadequate or undesirable, invasive electrophysiology techniques are a viable treatment option. Increasing experience with radiofrequency catheter ablation techniques has led to improved success rates and decreased complication rates. New technologies, such as nonradiographic mapping systems and novel ablation catheters, are additional tools that can improve the ability of pediatric electrophysiologists to approach treating tachycardia mechanisms that have previously been too challenging to treat safely.
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Affiliation(s)
- Terrence U H Chun
- Division of Pediatric Cardiology, Seattle Children's Hospital and Regional Medical Center, 4800 Sandpoint Way NE, Seattle, WA 98105, USA
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40
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Dong J, Zrenner B, Schreieck J, Schmitt C. Necessity for Biatrial Ablation to Achieve Bidirectional Cavotricuspid Isthmus Conduction Block in a Patient Following Senning Operation. J Cardiovasc Electrophysiol 2004; 15:945-9. [PMID: 15333093 DOI: 10.1046/j.1540-8167.2004.03628.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report the case of a 28-year-old male patient with a 17-year history of recurrent symptomatic atrial tachyarrhythmia following Senning operation for transposition of the great arteries. Biatrial electroanatomic mapping and entrainment mapping revealed counterclockwise peri-tricuspid annulus reentry in which cavotricuspid isthmus tissue in both systemic and pulmonary venous atria was involved. Linear ablation of the cavotricuspid isthmus in the pulmonary venous atrium terminated the tachycardia but did not block the isthmus conduction, and the tachycardia was reinduced. Bidirectional isthmus conduction block could be achieved only after additional linear ablation targeting the cavotricuspid isthmus tissue in the systemic venous atrium. We conclude that biatrial ablation may be necessary in order to achieve bidirectional isthmus block and prevent tachycardia recurrence in some patients following Senning or Mustard operation.
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Affiliation(s)
- Jun Dong
- Deutsches Herzzentrum München and 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
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