Intraatrial reentrant tachycardias in patients after atrial switch procedures for d-transposition of the great arteries

Abstract

Thirteen patients with d-transposition of the great arteries after the Mustard/Senning procedure underwent electrophysiological study for recurrent intraatrial reentrant tachycardia (IARTs). In 8 patients, a 20-pole electrode catheter and a steerable 7F mapping and ablation catheter were placed in the systemic venous atrium, and via the retrograde route in the pulmonary venous atrium, if required. During IART pace mapping and entrainment mapping were performed in order to localize protected areas of atrial tissue between anatomical and/or surgical barriers of electrical isolation. The systemic venous atrium of 5 patients was studied using the non-contact mapping system (Ensite 3000(TM)). Linear radiofrequency current lesions were induced after mapping of electrical protected areas from the medial aspect of the superior caval vein to the systemic venous atrium and/or intraatrial baffle or the intraatrial suture line in 4 patients, from the medial aspect of mitral valve annulus to the inferior caval vein in 5 patients, from the intraatrial suture line to the posterior systemic venous atrium in 1 patient and in 2 patients from the posterior and inferior pulmonary venous atrium to the tricuspid valve annulus. Subsequently, 14 of the 15 identified IARTs were not inducible during repeated programmed stimulation. Mean duration of the electrophysiological study was 202 min, mean fluoroscopy time was 21.6 min. During follow-up (mean 20 months), 10 of 12 patients with successful procedures are free of tachycardia, 2 patients developed IARTs with a new morphology. In the majority of our patients, curative treatment was feasible by induction of linear radiofrequency current lesions by primarily targeting electrical protected areas of atrial tissue in the systemic venous atrium.

Mapping of Intraatrial Reentrant Tachycardias by Remote Magnetic Navigation in Patients with d‐Transposition of the Great Arteries After Mustard or Senning Procedure

“…There is one report describing only the procedure and fluoroscopy times of SVA mapping and ablation using a noncontact mapping system, 7 which is also not comparable to our study. Looking at a previous study from our institution 8 the mean fluoroscopy time was reduced from 64 minutes (16–158 minutes) using conventional electroanatomic mapping to 37.3 minutes (17.3–61 minutes) with RMN.…”

“…As to the effectiveness of ablation, although nonirrigated tip catheters have been used to ablate IART in congenital heart disease, 6,7 ablation with irrigated tip catheters has been shown to be more effective by creating deeper lesions in these thick‐walled atria 17,20 . Triedman et al .…”

“…3,4 This manuscript was processed by a guest editor. Since the initial experience with mapping and catheter ablation of IART, 5,6 different mapping techniques, such as noncontact mapping 7 and electroanatomic mapping, 8 have been introduced to facilitate the procedure and to improve ablation success.…”

Atrial tachyarrhythmias after atrial switch operation for transposition of the great arteries: Treating old surgery with new catheters

“…24,39 Factors predisposing patients to IART include atrial scarring caused by multiple atriotomies, long suture lines and pericardial inflammation, implanted prosthetic or pericardial patches, abnormal atrial wall stress in disordered hemodynamic states, abnormal atrial anatomy and changes in atrial refractoriness associated with sinus node dysfunction and concomitant bradycardia. 33 Acute success rates of ablation of IART in patients after the Mustard or Senning correction ranged from 73 to 100% and recurrences were not often observed. 21,27,33,36,37 In the study of 9 Zrenner et al, repeat ablation of recurrent IART -all with similar reentry circuits as the initial tachycardia -was performed successfully in 3 patients (100%).…”

“…33 Acute success rates of ablation of IART in patients after the Mustard or Senning correction ranged from 73 to 100% and recurrences were not often observed. 21,27,33,36,37 In the study of 9 Zrenner et al, repeat ablation of recurrent IART -all with similar reentry circuits as the initial tachycardia -was performed successfully in 3 patients (100%). 27 Focal atrial tachycardia FAT originates from a small circumscribed region from where it expands centrifugally to the remainder of the atria.…”