Ablation of ‘Incisional’ Reentrant Atrial Tachycardia Complicating Surgery for Congenital Heart Disease

Kalman, Jonathan M.; VanHare, George F.; Olgin, Jeffrey E.; Saxon, Leslie A.; Stark, Stephen; Lesh, Michael D.

doi:10.1161/01.cir.93.3.502

Cited by 318 publications

(209 citation statements)

References 25 publications

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“…Classically, PPI is expected to be the sum of the times required for the paced wave front to travel to and from the reentrant circuit plus the TCL. 6,8 However, if the pacing site is within or near a bystander reentrant loop that shares a common segment or isthmus with the true reentrant circuit, it is possible that the paced wave front takes different propagation pathways to and from the true reentrant circuit. Therefore, the return cycle at that site after the last paced beat of entrainment pacing may not include the entire TCL but instead represents the revolution time around the bystander reentrant loop itself.…”

Section: Discussionmentioning

confidence: 99%

Lower Loop Reentry as a Mechanism of Clockwise Right Atrial Flutter

et al. 2004

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Background-Right atrial reentrant tachycardia resulting from lower loop reentry (LLR) around the inferior vena cava (IVC) has been described recently. However, all reported cases of LLR in the literature have negative flutter waves on the inferior surface ECG leads similar to that of counterclockwise typical atrial flutter around the tricuspid annulus (TA). Right atrial flutter with positive flutter waves in the inferior ECG leads has been assumed to rotate as a single reentrant activation wave front around the TA, and the role of LLR in those patients is not known. Methods and Results-Twelve consecutive patients with flutter wave morphology on surface ECG consistent with clockwise atrial flutter were studied. The endocardial activation pattern recorded from conventional multipolar electrode catheters was characteristic of clockwise atrial flutter around the TA. Entrainment pacing in all 12 patients and 3D activation sequence mapping in 7 patients, however, revealed clockwise LLR involving the lower right atrium around the IVC in 7 patients, figure-of-8 double-loop reentry around both the IVC and TA in 4, and single reentrant loop around the TA in 1. Linear radiofrequency ablation in the isthmus between the TA and IVC (TI isthmus) terminated the tachycardia in all patients. Conclusions-Surface ECG flutter wave morphology and limited recording intracardiac sites proved insufficient to delineate the precise mechanism of the TI isthmus-dependent clockwise right atrial flutters. Most right atrial flutters with positive flutter wave on surface ECG may be supported by a reentrant circuit around the IVC or a figure-of-8 double-loop reentry involving both the IVC and TA.

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Section: Discussionmentioning

confidence: 99%

Lower Loop Reentry as a Mechanism of Clockwise Right Atrial Flutter

et al. 2004

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“…Electrophysiological studies in patients with AT after surgical repair are generally performed for stable AT, allowing easy identification of the reentrant circuit [1] [2]. In this patient, however, AT could not be induced despite any provocation methods.…”

Section: Discussionmentioning

confidence: 99%

“…Atrial tachycardia (AT) is observed occasionally in patients after atriotomy for surgical repair of heart disease [1] [2]. Sustained AT generally results from macroreentry around the atriotomy scar and cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL).…”

Section: Introductionmentioning

confidence: 99%

Catheter ablation of non-inducible atrial tachycardia after surgical repair of heart disease

et al. 2011

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We present a patient with non-inducible atrial tachycardia (AT) after atriotomy for surgical repair of heart disease who underwent ablation successfully. Using a 3D mapping system, we presumed the atriotomy site on the lateral right atrial wall by searching for linear double potentials (DP) during sinus/paced rhythm from the coronary sinus, but it was evaluated incompletely. We could verify the edges of the atriotomy scar precisely by pacing from close to the linear DP lesion and the opposite site. After ablation between the presumed atriotomy scar and the inferior vena cava and cavotricuspid isthmus, no AT recurred without anti-arrhythmic drugs.

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“…Standard definitions were used to define successful tachycardia entrainment. 6,9,10 The PPI was measured from the last stimulus artifact to the beginning of the first rapid deflection of the RVA electrogram.…”

Section: Entrainment Pacing Protocolmentioning

confidence: 99%

“…9,10 We postulated ( Figure 1) that BBR-VT entrainment pacing from the right ventricular apex (RVA) should result in a PPI similar to the tachycardia CL (TCL) because the right bundle-branch distal insertion is in this anatomic area. This approach may differentiate BBR from other mechanisms of wide-QRS-complex tachycardia with AV dissociation, 3,11 such as ventricular myocardial reentry (MR) or AV nodal reentry (AVNR), where the circuit is usually away from the RVA.…”

mentioning

confidence: 99%

Bundle-Branch Reentry and the Postpacing Interval After Entrainment by Right Ventricular Apex Stimulation

Merino¹,

Peinado²,

Fernández‐Lozano³

et al. 2001

Circulation

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Background-Diagnosis of bundle-branch reentry ventricular tachycardia (BBR-VT) by the standard approach is challenging, and this may lead to nonrecognition of this tachycardia mechanism. Because the postpacing interval (PPI) after entrainment has been correlated with the distance from the pacing site to the reentrant circuit, BBR-VT entrainment by pacing from the right ventricular apex (RVA) should result in a PPI similar to the tachycardia cycle length (TCL). This factor may differentiate BBR-VT from other mechanisms of wide-QRS-complex tachycardia with AV dissociation, such as myocardial reentrant VT (MR-VT) or AV nodal reentrant tachycardia (AVNRT), in which the circuit is usually located away from the RVA. Methods and Results-Transient entrainment by RVA pacing was attempted in 18 consecutive BBR-VTs and finally achieved in 13. Results were compared with those found in 59 consecutive MR-VTs and 50 consecutive AVNRTs. The mean PPIϪTCL difference was significantly (PϽ0.0001) shorter in the BBR-VT group (9Ϯ11 ms) than in the MR-VT (109Ϯ48 ms) and the AVNRT (150Ϯ29 ms) groups. No BBR-VT showed a PPIϪTCL Ͼ30 ms (range Ϫ12 to 24 ms). Except for 2 MR-VTs, no MR-VT (range 21 to 211 ms) or AVNRT (range 100 to 215 ms) showed a PPIϪTCL Ͻ30 ms. Conclusions-A PPIϪTCL Ͼ30 ms, after entrainment by RVA stimulation, makes BBR-VT unlikely. Conversely, a PPIϪTCL Ͻ30 ms is suggestive of BBR-VT but should lead to further investigation by use of conventional criteria.

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Ablation of ‘Incisional’ Reentrant Atrial Tachycardia Complicating Surgery for Congenital Heart Disease

Cited by 318 publications

References 25 publications

Lower Loop Reentry as a Mechanism of Clockwise Right Atrial Flutter

Lower Loop Reentry as a Mechanism of Clockwise Right Atrial Flutter

Catheter ablation of non-inducible atrial tachycardia after surgical repair of heart disease

Bundle-Branch Reentry and the Postpacing Interval After Entrainment by Right Ventricular Apex Stimulation

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