Characterization of intraatrial reentrant tachycardia in patients after mustard operation for transposition of great arteries using electroanatomic and entrainment mapping

Necessity for Biatrial Ablation to Achieve Bidirectional Cavotricuspid Isthmus Conduction Block in a Patient Following Senning Operation

“…Interestingly, most of the IARTs following corrective operations for congenital heart disease are cavotricuspid isthmus dependent 11–13 . This also is the case in patients after Mustard or Senning operation 3–5 . In a previous study, we found that 77% of IARTs following Mustard operation were cavotricuspid isthmus‐dependent peri‐tricuspid annulus reentry 5 .…”

“…[11][12][13] This also is the case in patients after Mustard or Senning operation. [3][4][5] In a previous study, we found that 77% of IARTs following Mustard operation were cavotricuspid isthmus-dependent peri-tricuspid annulus reentry. 5 Moreover, we identified that in all patients in whom the mid-cavotricuspid isthmus was bisected by the inferior baffle suture line, both pulmonary and systemic venous atria portions of the cavotricuspid isthmus were involved in the peri-tricuspid annulus reentry.…”

“…As described in our previous study, 5 alternative ablation strategies can be performed after delineation of the IART circuit and its boundary under the guidance of electroanatomic mapping and entrainment mapping. In the present case, a linear lesion bridging the incisional scar on the free wall of the pulmonary venous atrium to the lateral tricuspid annulus other than biatrial isthmus ablation may be considered as alternative approach, although most often isthmus ablation is performed more easily with regard to catheter stability even using a retrograde approach to access the pulmonary venous atrium.…”

“…1,2 Cavotricuspid isthmus-dependent reentry was found to be the most frequent type of IART in this group of patients. [3][4][5] Radiofrequency (RF) catheter ablation targeting the cavotricuspid isthmus achieved favorable results. [3][4][5] However, little is known about the creation and evaluation of cavotricuspid isthmus conduction block.…”

“…[3][4][5] Radiofrequency (RF) catheter ablation targeting the cavotricuspid isthmus achieved favorable results. [3][4][5] However, little is known about the creation and evaluation of cavotricuspid isthmus conduction block. We report a case in which the cavotricuspid isthmus tissue in both the systemic and pulmonary venous atria were necessarily targeted in order to achieve bidirectional isthmus conduction block in a patient following Senning operation.…”