Long-Term Outcome After Ablation of Right Atrial Tachyarrhythmias After the Surgical Repair of Congenital and Acquired Heart Disease

Anguera, Ignasi; Dallaglio, Paolo; Macías, Rosa; Jiménez‐Candil, Javier; Peinado, Rafaél; García‐Seara, Javier; Arcocha, María Fe; Herreros, Benito; Quesada, Aurelio; Hernández‐Madrid, Antonio; Álvarez, Miguel; Filgueiras, David; Matía, Roberto; Cequier, Ángel; Sabaté, Xavier

doi:10.1016/j.amjcard.2015.03.017

Cited by 27 publications

(11 citation statements)

References 28 publications

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“…Device-related serious adverse events were reported to be 0.57-1.25% (39,40) and might be even lower as supported by our experience from more than 500 procedures. Our findings regarding radiation exposure and safety outcome were comparable to previously published studies having used conventional point-by-point mapping in adult patients with different CHD-related arrhythmias (41,42).…”

Section: Safetysupporting

confidence: 88%

Advanced mapping strategies for ablation therapy in adults with congenital heart disease

Alken¹,

Klatt²,

Muenkler³

et al. 2019

Cardiovasc. Diagn. Ther.

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Background: Ultra-high density mapping (HDM) is a promising tool in the treatment of patients with complex arrhythmias. In adults with congenital heart disease (CHD), rhythm disorders are among the most common complications but catheter ablation can be challenging due to heterogenous anatomy and complex arrhythmogenic substrates. Here, we describe our initial experience using HDM in conjunction with novel automated annotation algorithms in patients with moderate to great CHD complexity.Methods: We studied a series of consecutive adult patients with moderate to great CHD complexity and an indication for catheter ablation due to symptomatic arrhythmia. HDM was conducted using the Rhythmia™ mapping system and a 64-electrode mini-basket catheter for identification of anatomy, voltage, activation pattern and critical areas of arrhythmia for ablation guidance. To investigate novel advanced mapping strategies, postprocedural signal processing using the Lumipoint™ software was applied.Results: In 19 patients (53±3 years; 53% male), 21 consecutive ablation procedures were conducted.Procedures included ablation of atrial fibrillation (n=7; 33%), atrial tachycardia (n=11; 52%), atrioventricular accessory pathway (n=1; 5%), the atrioventricular node (n=1; 5%) and ventricular arrhythmias (n=4; 19%). A total of 23 supraventricular and 8 ventricular arrhythmias were studied with the generation of 56 complete high density maps (atrial n=43; ventricular n=11, coronary sinus n=2) and an average of 12,043±1,679 mapping points. Multiple arrhythmias were observed in n=7 procedures (33% of procedures; range of arrhythmias detected 2-4). A total range of 1-4 critical areas were defined per procedure and treated within a radiofrequency application time of 16 (interquartile range 12-45) minutes. Postprocedural signal processing using Lumipoint™ allowed rapid annotation of fractionated signals within specific windows of interest.This supported identification of a practical critical isthmus in 20 out of 27 completed atrial and ventricular tachycardia activation maps.Conclusions: Our findings suggest that HDM in conjunction with novel automated annotation algorithms provides detailed insights into arrhythmia mechanisms and might facilitate tailored catheter ablation in patients with moderate to great CHD complexity.

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Section: Safetysupporting

confidence: 88%

Advanced mapping strategies for ablation therapy in adults with congenital heart disease

Alken¹,

Klatt²,

Muenkler³

et al. 2019

Cardiovasc. Diagn. Ther.

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show abstract

“…Due to the anatomy present in these patients, mapping and ablation can be labor and time exhaustive. Success of ablation of atrial arrhythmias in adults with congenital heart disease is also lower than that of ablation of the same arrhythmias in adults with structurally normal hearts . This is particularly noted with intraatrial reentrant tachycardia and atrial fibrillation …”

Section: Discussionmentioning

confidence: 99%

Arrhythmias in Adults with Congenital Heart Disease: What Are Risk Factors for Specific Arrhythmias?

Loomba

Buelow

Aggarwal

et al. 2017

Pacing Clinical Electrophis

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“…during follow-up. 1,2 Commonly occurring AFL circuits related to RA atriotomy are limited to two types: CTI dependent and RA peri-incisional AFL. 3 Recurrent flutter after targeting one of the two circuits likely utilizes the other unablated circuit.…”

mentioning

confidence: 99%

Is prophylactic ablation of the cavotricuspid and peri‐incisional isthmus justified in patients with postoperative atrial flutter after right atriotomy?

Benák

Kupó

Bencsik

et al. 2022

Cardiovasc electrophysiol

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Background: The two most common postoperative atrial flutter (AFL) circuits after right atriotomy are the cavotricuspid isthmus (CTI) dependent and the lateral, peri-incisional. We investigated whether radiofrequency ablation (RFA) of both circuits results in more favorable long-term outcomes. Methods: Single-center retrospective cohort study of consecutive patients who underwent RFA of AFL after open-heart surgery. The effect of surgery type and RFA strategy on AFL recurrence was evaluated. Results: One hundred and forty-two patients (mean age 64.5 ± 12.7 years, 65.% male) were enrolled. Patients with right atrial (RA) flutter (n = 124) were divided into two groups based on the index RFA procedure: only one RA circuit was ablated (Group 1, n = 84, 67.7%) or both the CTI and the peri-incisional circuit ablated (Group 2, n = 40, 32.3%). The previous open-heart surgery was categorized based on the extension of the RA incision: limited (Type A) or extended (Type B) atriotomy.After a mean follow-up of 36 ± 28 months, flutter recurrence was not different among patients with limited RA atriotomy (25% vs. 22% in Groups 1A and 2A, respectively, p = 1.0). However, after type B surgery, ablation of both AFL circuits was associated with a reduced recurrence rate (63% vs. 26% in Groups 1B and 2B, respectively, p = .002). Conclusions:In patients with postoperative RA flutter after extended right atriotomy, ablation of both the CTI and the peri-incisional isthmus significantly reduces the AFL recurrence rate. Prophylactic ablation of both isthmi, even if not proven to support reentry, is reasonable in this population.

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Long-Term Outcome After Ablation of Right Atrial Tachyarrhythmias After the Surgical Repair of Congenital and Acquired Heart Disease

Cited by 27 publications

References 28 publications

Advanced mapping strategies for ablation therapy in adults with congenital heart disease

Advanced mapping strategies for ablation therapy in adults with congenital heart disease

Arrhythmias in Adults with Congenital Heart Disease: What Are Risk Factors for Specific Arrhythmias?

Is prophylactic ablation of the cavotricuspid and peri‐incisional isthmus justified in patients with postoperative atrial flutter after right atriotomy?

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