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Roca-Luque I, Rivas Gándara N, Dos Subirà L, Francisco Pascual J, Pérez-Rodon J, Pijuan Domenech A, Subirana MT, Miranda B, Santos Ortega A, Casaldàliga Ferrer J, García-Dorado García D, Moya Mitjans A. Intra-atrial re-entrant tachycardia in patients with congenital heart disease: factors associated with disease severity. Europace 2018; 20:1343-1351. [PMID: 29016882 DOI: 10.1093/europace/eux180] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 05/03/2017] [Indexed: 11/14/2022] Open
Abstract
Aim Intra-atrial re-entrant tachycardia (IART) is a common complication in patients with congenital heart disease (CHD) and is related to increased morbidity and mortality. Few reports have been published about factors associated to IART severity. The aim of this study is to analyse factors associated to severe clinical presentation of IART. Methods and Results Observational study of all consecutive CHD patients who underwent a first IART ablation from January 2009 to December 2015 (94 patients, 39.4% female, and age: 36.55 ± 14.9 years). Severe clinical presentation was defined as heart failure, syncope, shock, electromechanical dissociation (EMD), or aborted sudden death. The majority of patients had moderately or highly complex cardiac defect (90.4%). Types of IART included cavotricuspid isthmus(CTI) dependent in 51% (48), non-CTI-related in 22.3% (20), and both types in 27.7% (26). In 38 patients (40.4%), a severe event occurred and in 16 (17%), the symptoms included shock, syncope, sudden death, or EMD. In 21 (22.3%), severe symptoms were the first manifestation of IART. In multivariate analysis, transposition of the great arteries (TGA) with right systemic ventricle (OR 5.32, 95% C.I. 1.6-7.02, P = 0.0005) and severe dilation of the venous atrium (VsA) (OR 4.17; 95% CI 1.4-8.12, P = 0.0009) were factors independently associated with severity. Conclusion In our series of 94 CHD patients with a high proportion of moderately to highly complex cardiac defects, severe consequences of IART were frequent. Transposition of the great arteries with systemic right ventricle and severe dilation of VsA were independently associated to severity. Early invasive procedures should be considered for these high-risk patients.
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Affiliation(s)
- Ivo Roca-Luque
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Pg Vall d' Hebron 119-129, Barcelona, Spain
| | - Nuria Rivas Gándara
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Pg Vall d' Hebron 119-129, Barcelona, Spain
| | - Laura Dos Subirà
- Grown-Up Congenital Heart Disease Unit, Cardiology Service, Hospital Universitari Val d'Hebron, Spain
| | - Jaume Francisco Pascual
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Pg Vall d' Hebron 119-129, Barcelona, Spain
| | - Jordi Pérez-Rodon
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Pg Vall d' Hebron 119-129, Barcelona, Spain
| | - Antònia Pijuan Domenech
- Grown-Up Congenital Heart Disease Unit, Cardiology Service, Hospital Universitari Val d'Hebron, Spain
| | - Ma Teresa Subirana
- Grown-Up Congenital Heart Disease Unit, Cardiology Service, Hospital Universitari Val d'Hebron, Spain
| | - Berta Miranda
- Grown-Up Congenital Heart Disease Unit, Cardiology Service, Hospital Universitari Val d'Hebron, Spain
| | - Alba Santos Ortega
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Pg Vall d' Hebron 119-129, Barcelona, Spain
| | - Jaume Casaldàliga Ferrer
- Grown-Up Congenital Heart Disease Unit, Cardiology Service, Hospital Universitari Val d'Hebron, Spain
| | | | - Angel Moya Mitjans
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Pg Vall d' Hebron 119-129, Barcelona, Spain
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Roca-Luque I, Rivas Gándara N, Dos Subirà L, Pascual JF, Domenech AP, Pérez-Rodon J, Subirana MT, Santos Ortega A, Miranda B, Rosés-Noguer F, Ferreira-Gonzalez I, Ferrer JC, García-Dorado García D, Mitjans AM. Intra-atrial re-entrant tachycardia in congenital heart disease: types and relation of isthmus to atrial voltage. Europace 2017; 20:353-361. [PMID: 29016802 DOI: 10.1093/europace/eux250] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 07/03/2017] [Indexed: 11/13/2022] Open
MESH Headings
- Action Potentials
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Atrial Function
- Catheter Ablation
- Child
- Child, Preschool
- Electrophysiologic Techniques, Cardiac
- Female
- Heart Atria/physiopathology
- Heart Atria/surgery
- Heart Conduction System/physiopathology
- Heart Conduction System/surgery
- Heart Defects, Congenital/complications
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/physiopathology
- Heart Rate
- Humans
- Male
- Middle Aged
- Tachycardia, Atrioventricular Nodal Reentry/diagnosis
- Tachycardia, Atrioventricular Nodal Reentry/etiology
- Tachycardia, Atrioventricular Nodal Reentry/physiopathology
- Tachycardia, Atrioventricular Nodal Reentry/surgery
- Young Adult
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Affiliation(s)
- Ivo Roca-Luque
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Passeig Vall d' Hebron 119-129, 08035 Barcelona, Spain
| | - Nuria Rivas Gándara
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Passeig Vall d' Hebron 119-129, 08035 Barcelona, Spain
| | - Laura Dos Subirà
- Adult Congenital Heart Disease Unit, Cardiology Service, Hospital Universitari Val d'Hebron, Passeig Vall d' Hebron 119-129, Barcelona, Spain
| | - Jaume Francisco Pascual
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Passeig Vall d' Hebron 119-129, 08035 Barcelona, Spain
| | - Antònia Pijuan Domenech
- Adult Congenital Heart Disease Unit, Cardiology Service, Hospital Universitari Val d'Hebron, Passeig Vall d' Hebron 119-129, Barcelona, Spain
| | - Jordi Pérez-Rodon
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Passeig Vall d' Hebron 119-129, 08035 Barcelona, Spain
| | - M Teresa Subirana
- Adult Congenital Heart Disease Unit, Cardiology Service, Hospital Universitari Val d'Hebron, Passeig Vall d' Hebron 119-129, Barcelona, Spain
| | - Alba Santos Ortega
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Passeig Vall d' Hebron 119-129, 08035 Barcelona, Spain
| | - Berta Miranda
- Adult Congenital Heart Disease Unit, Cardiology Service, Hospital Universitari Val d'Hebron, Passeig Vall d' Hebron 119-129, Barcelona, Spain
| | - Ferran Rosés-Noguer
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Passeig Vall d' Hebron 119-129, 08035 Barcelona, Spain
| | - Ignacio Ferreira-Gonzalez
- Ciber CV Research Unit, Hospital Universitari Vall d' Hebron, Passeig Vall d' Hebron 119-129, Barcelona, Spain
| | - Jaume Casaldàliga Ferrer
- Adult Congenital Heart Disease Unit, Cardiology Service, Hospital Universitari Val d'Hebron, Passeig Vall d' Hebron 119-129, Barcelona, Spain
| | - David García-Dorado García
- Ciber CV Research Unit, Hospital Universitari Vall d' Hebron, Passeig Vall d' Hebron 119-129, Barcelona, Spain
| | - Angel Moya Mitjans
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Passeig Vall d' Hebron 119-129, 08035 Barcelona, Spain
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