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Bhargav A, Sukumaran SK, Balaguru S, Selvaraj RJ. A short RP tachycardia in congenitally corrected transposition. What is the mechanism? Pacing Clin Electrophysiol 2024; 47:239-241. [PMID: 38264970 DOI: 10.1111/pace.14927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 12/30/2023] [Accepted: 01/05/2024] [Indexed: 01/25/2024]
Abstract
A 51-year-old female with congenitally corrected transposition of great arteries (CCTGA), situs solitus, dextrocardia, atrial septal defect and persistent left superior vena cava underwent electrophysiology study for recurrent palpitations with documented narrow complex, short RP tachycardia. With a catheter in the region of the anterior mitral annulus, a His signal was recorded and HV interval was 35 msec. Tachycardia was induced with a ventricular extrastimulus. During the tachycardia there was 1:1 ventriculo-atrial conduction and central atrial activation with a VA interval of 20 msec. The recorded His signal could be seen after the QRS. What is the mechanism of the tachycardia?
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Affiliation(s)
- Anish Bhargav
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Suresh Kumar Sukumaran
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sridhar Balaguru
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Raja J Selvaraj
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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2
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Kong J, Ge X, Wu Y, Meng X, Rong B, Zhang K, Zhong J. Atrial tachycardia ablation at the pulmonary outflow tract in a patient with congenitally corrected transposition of the great arteries. HeartRhythm Case Rep 2023; 9:489-492. [PMID: 37492055 PMCID: PMC10363455 DOI: 10.1016/j.hrcr.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Affiliation(s)
- Jing Kong
- National Key Laboratory for Innovation and Transformation of Luobing Theory; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences; Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiao Ge
- National Key Laboratory for Innovation and Transformation of Luobing Theory; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences; Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yang Wu
- Department of Cardiology, Weihai Municipal Hospital, Weihai, China
| | - Xiao Meng
- National Key Laboratory for Innovation and Transformation of Luobing Theory; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences; Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Bing Rong
- National Key Laboratory for Innovation and Transformation of Luobing Theory; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences; Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Kai Zhang
- National Key Laboratory for Innovation and Transformation of Luobing Theory; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences; Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jingquan Zhong
- National Key Laboratory for Innovation and Transformation of Luobing Theory; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences; Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Cardiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
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Waldmann V, Hebe J, Walsh EP, Khairy P, Ernst S. Catheter Ablation of Atrioventricular Nodal Reentrant Tachycardia in Patients With Congenital Heart Disease. Circ Arrhythm Electrophysiol 2022; 15:e010631. [PMID: 35089803 DOI: 10.1161/circep.121.010631] [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
Atrioventricular (AV) nodal reentrant tachycardia represents the most common regular supraventricular arrhythmia in humans, and catheter ablation of the so called slow AV nodal pathway has been effectively performed for decades. In patients with congenital heart disease, a combination of different factors makes catheter ablation of AV nodal reentrant tachycardia substrate particularly challenging, including abnormal venous access to intracardiac structures, abnormal intracardiac anatomy, potentially deviant and often unpredictable sites of the specific conduction system, loss of traditional anatomic landmarks, and congenital cardiac surgery that may complicate the access to the AV nodal area. Published experiences have confirmed the efficacy and the relative safety of such procedures when performed by experts, but the risk of complications, in particular AV block, remains non-negligible. A thorough knowledge and understanding of anatomic and electrical specificities according to underlying phenotype are essential in addressing these complex cases. Considering the major consequences associated with AV block in patients with complex congenital heart disease, particularly those without low risk access for transvenous ventricular pacing (eg, single ventricle physiology or Eisenmenger syndrome), the individual risk-benefit ratio should be carefully evaluated. The decision to defer ablation may be the wisest approach in selected patients with either infrequent or hemodynamically tolerated arrhythmias, or when the location of the AV conduction pathways remains uncertain. This narrative review aims to synthetize existing literature on catheter ablation of AV nodal reentrant tachycardia in congenital heart disease, to present main features of common associated pathologies, and to discuss approaches to mapping and safely ablating the slow AV nodal pathway in challenging cases.
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Affiliation(s)
- Victor Waldmann
- Electrophysiology and Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France (V.W.).,Pediatric and Congenital Heart Disease Department, Necker Hospital, Paris, France (V.W.)
| | - Joachim Hebe
- Center for Electrophysiology Bremen at Heart Center Bremen, Germany (J.H.)
| | - Edward P Walsh
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, MA (E.P.W.)
| | - Paul Khairy
- Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Quebec, Canada (P.K.)
| | - Sabine Ernst
- Royal Brompton Hospital, Guys and St. Thomas' NHS Foundation Trust, London, United Kingdom (S.E.).,National Heart and Lung Institute, Imperial College, London, United Kingdom (S.E.)
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Baruteau AE, Abrams DJ, Ho SY, Thambo JB, McLeod CJ, Shah MJ. Cardiac Conduction System in Congenitally Corrected Transposition of the Great Arteries and Its Clinical Relevance. J Am Heart Assoc 2017; 6:JAHA.117.007759. [PMID: 29269355 PMCID: PMC5779063 DOI: 10.1161/jaha.117.007759] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Alban-Elouen Baruteau
- Department of Congenital Cardiology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom .,M3C CHU de Nantes, Fédération des Cardiopathies Congénitales, Nantes, France
| | - Dominic J Abrams
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Siew Yen Ho
- Cardiac Morphology, Royal Brompton Hospital and Harefield NHS Foundation Trust, Imperial College London, London, United Kingdom
| | - Jean-Benoit Thambo
- Department of Paediatric Cardiology, CHU Bordeaux, Pessac, France.,IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France
| | - Christopher J McLeod
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN
| | - Maully J Shah
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
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Adler AC, Kodavatiganti R. Mechanical Support With Impella During Malignant Arrhythmia Ablation: A Case Report on the Growing Trend in the Electrophysiology Laboratory. ACTA ACUST UNITED AC 2017; 8:282-285. [PMID: 28328585 DOI: 10.1213/xaa.0000000000000490] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Congenitally corrected transposition of the great arteries is a rare form of congenital heart disease in which the persistence of the right ventricle as the systemic ventricle leads to heart failure, tricuspid valve insufficiency, and arrhythmia. Supraventricular arrhythmias are especially common in these patients. We discuss the anesthetic management of a 33-year-old patient with congenitally corrected transposition of the great arteries who required a ventricular assist device to maintain cardiac output during ablation of supraventricular tachyarrythmia. A witnessed pulseless cardiac arrest and resuscitation during a previous episode of supraventricular tachycardia prompted the elective insertion of the Impella catheter after induction of anesthesia for the ablation procedure.
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Affiliation(s)
- Adam C Adler
- From the *Department of Anesthesiology, Perioperative and Pain Medicine, Division of Cardiovascular Anesthesiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas; and †The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, Division of Cardiothoracic Anesthesiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Kodliwadmath A. Congenitally corrected transposition of great vessels with infundibular pulmonary stenosis with ventricular septal defect, presenting with atypical atrioventricular nodal reentrant tachycardia: a rare association. Int Med Case Rep J 2017; 10:319-322. [PMID: 28989287 PMCID: PMC5624594 DOI: 10.2147/imcrj.s143361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Congenitally corrected transposition of great vessels (CCTGV) is a rare congenital heart disease (CHD) accounting for <1% of CHDs. CCTGV with infundibular pulmonary stenosis (PS) with ventricular septal defect (VSD) is part of Fallot’s physiology. It is known to be associated with bradyarrhythmias like atrioventricular (AV) blocks, and acquired complete AV block occurs at a rate of 2% per year. Patients can have left-sided accessory pathways, which may cause atrioventricular reentrant tachycardia (AVRT). Tachyarrhythmias like atrioventricular nodal reentrant tachycardia (AVNRT) are very rare in such patients. A 30-year-old woman, a known case of CCTGV with PS with VSD, not corrected surgically and not on any drugs, presented with the syndrome of paroxysmal supraventricular tachycardia without hemodynamic compromise. Electrocardiogram showed atypical AVNRT. She was pharmacologically cardioverted to normal sinus rhythm with adenosine. CTGV with PS with VSD known to be associated with AV blocks, and preexcitation can sometimes present with atypical AVNRT.
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Affiliation(s)
- Ashwin Kodliwadmath
- Department of Medicine, Belgaum Institute of Medical Sciences, Belgaum, Karnataka, India
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Moore JP, Aboulhosn JA. Introduction to the Congenital Heart Defects: Anatomy of the Conduction System. Card Electrophysiol Clin 2017; 9:167-175. [PMID: 28457233 DOI: 10.1016/j.ccep.2017.02.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The position and course of the conduction system in congenital heart disease are intricately tied to the underlying congenital malformation. Although only subtle differences exist between the anatomy of the conduction axis for simple congenital heart lesions and normal anatomy, almost every patient with congenital heart disease harbors some important anatomic variation. This article summarizes the body of literature by retaining original classical concepts and by attempting to translate the available knowledge into useful points for the congenital heart disease specialist. This discussion spans the entire spectrum of simple to complex congenital heart disease.
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Affiliation(s)
- Jeremy P Moore
- UCLA Medical Center, Ahmanson/UCLA Adult Congenital Heart Disease Center, David Geffen School of Medicine at UCLA, 100 Medical Plaza Drive, Suite 770, Los Angeles, CA 90095, USA.
| | - Jamil A Aboulhosn
- UCLA Medical Center, Ahmanson/UCLA Adult Congenital Heart Disease Center, David Geffen School of Medicine at UCLA, 100 Medical Plaza Drive, Suite 770, Los Angeles, CA 90095, USA
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Roca-Luque I, Rivas N, Francisco J, Perez-Rodon J, Dos L, Moya A, García-Dorado D. Para-Hisian atrial tachycardia ablation in a patient with congenitally corrected transposition of great vessels. HeartRhythm Case Rep 2017; 3:340-343. [PMID: 28748140 PMCID: PMC5511984 DOI: 10.1016/j.hrcr.2017.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ivo Roca-Luque
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d' Hebron, CIBERCV, Barcelona, Spain.,Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d' Hebron, Barcelona, Spain
| | - Nuria Rivas
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d' Hebron, Barcelona, Spain
| | - Jaume Francisco
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d' Hebron, Barcelona, Spain
| | - Jordi Perez-Rodon
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d' Hebron, Barcelona, Spain
| | - Laura Dos
- Grown-up Congenital Heart Disease Unit, Hospital Universitari Vall d' Hebron, Barcelona, Spain
| | - Angel Moya
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d' Hebron, Barcelona, Spain
| | - David García-Dorado
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d' Hebron, Barcelona, Spain.,Cardiology Service, Hospital Universitari Vall d' Hebron, Barcelona, Spain
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