The Electroanatomic Mechanisms of Atrial Tachycardia in Patients with Tetralogy of Fallot and Double Outlet Right Ventricle

Mah, Douglas Y.; Alexander, Mark E.; Cecchin, Frank; Walsh, Edward P.; Triedman, John K.

doi:10.1111/j.1540-8167.2011.02062.x

Cited by 57 publications

(37 citation statements)

References 23 publications

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“…Though initial success rate for AT ablations was high, 19% of the patients experienced recurrent sustained AT within 6.5 months of follow-up [78]. Recurrence rate may decrease if both the CTI and lateral RA wall are ablated, even if single substrate region is detected by mapping [77].…”

Section: Catheter-based Ablation Therapymentioning

confidence: 99%

“…The success rate for treating VTs in rTOF patients by ablation varies from 50% to 91% according to the studies using electroanatomic substrate-based mapping approach [74,75]. Described VT recurrence rates remain high (up to 20%) in turn hindering wider use of this treatment strategy in patients with rTOF [76,77]. Effective ablation is even more complicated to achieve in patients who are haemodynamically unstable during VT.…”

Section: Catheter-based Ablation Therapymentioning

confidence: 99%

“…Cavotricuspid isthmus (CTI) and lateral right atrium (RA) wall served as conduction pathways of intraatrial macro-reentrant tachycardia (IART) circuits in 85% of rTOF and double outlet right ventricle patients [77]. Though initial success rate for AT ablations was high, 19% of the patients experienced recurrent sustained AT within 6.5 months of follow-up [78].…”

Section: Catheter-based Ablation Therapymentioning

confidence: 99%

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Late arrhythmia in patients with repaired tetralogy of Fallot: who is at risk?

Grigaliūnas

Gumbienė

Valevičienė

et al. 2015

Seminars in Cardiovascular Medicine

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SummaryTetralogy of Fallot (TOF) is the most common cause of cyanotic congenital heart defect. Over the last century, the life expectancy of TOF patients has significantly improved. This, however, has brought new challenges both to patients and their health-care providers, the main of them being late arrhythmia. Ironically, late arrhythmia is predominantly generated due to the fibrotic scars caused by the life-saving surgical repair. Once the first two mainly arrhythmia-free decades after the repair pass, the risk of developing late arrhythmia and, therefore, SCD becomes substantial. Consequently, young adults with repaired Tetralogy of Fallot (rTOF) require careful outpatient monitoring.There have been many attempts to predict the risk of life-threatening arrhythmia in rTOF patients. This has led to the defining of various risk factors, ranging from the widely used QRS prolongation to novel predictors, derived from cardiac magnetic resonance (CMR) based anatomical findings (left ventricular dyssynchrony indexes, right ventricular output tract akinetic length, right ventricular mass-to-volume ratio). The latter predictors have recently established CMR as a tool of high significance in evaluation of rTOF patients.Although the role of Holter monitoring findings in rTOF patient-assessment remains unclear, it may be useful in those who are 25 years and older. Implantable cardioverter-defibrillator (ICD) implantation is the first-line treatment for secondary prevention of sudden cardiac death (SCD). rTOF patients suffer from the highest rate of inappropriate and the lowest rate of appropriate ICD shocks, when compared to other congenital heart diseases. As a consequence, ICD implantation for primary SCD prevention should be carefully weighed. Catheter-based ablation therapy leads to high rate of initial success when abolishing monomorphic ventricular tachycardia and intra-atrial reentrant tachycardia, however recurrence rates remain high. Seminars in Cardiovascular Medicine

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Section: Catheter-based Ablation Therapymentioning

confidence: 99%

Section: Catheter-based Ablation Therapymentioning

confidence: 99%

Section: Catheter-based Ablation Therapymentioning

confidence: 99%

See 1 more Smart Citation

Late arrhythmia in patients with repaired tetralogy of Fallot: who is at risk?

Grigaliūnas

Gumbienė

Valevičienė

et al. 2015

Seminars in Cardiovascular Medicine

View full text Add to dashboard Cite

show abstract

“…Distinctive patterns for IART circuit location have been uncovered that vary according to underlying CHD lesion and method of repair, allowing one to predict with reasonable certainty the location of usual suspect sites for productive ablation. 8,9,[21][22][23] To take advantage of these patterns, intracardiac and venous anatomy must be well understood. Operative notes are mandatory reading because surgical techniques vary significantly among patients, surgeons, and eras.…”

Section: Ablation For Iart In Chdmentioning

confidence: 99%

“…These can include classic atrial flutter through the cavotricuspid isthmus, as well as atypical circuits related to atriotomy incisions and other scars. 8,9 The general term intra-atrial reentrant tachycardia (IART) has been used to describe all these circuits in CHD. Focal atrial tachycardia can also be observed in a small number of patients, usually arising from locations mapped in close proximity to a scar zone.…”

Section: Atrial Tachycardiasmentioning

confidence: 99%

Update on Interventional Electrophysiology in Congenital Heart Disease

Sherwin

Triedman

Walsh

2013

Circ: Arrhythmia and Electrophysiology

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Missing pouches in high‐density mapping of atrial tachyarrhythmia in congenital heart diseases

Kwok

Yung

et al. 2019

Journal of Arrhythmia

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Background The use of high‐density electroanatomical mapping in the Chinese population for congenital heart disease (CHD) is not well reported. Methods Retrospective review of consecutive transcatheter ablation of atrial tachyarrhythmia using high‐density mapping for CHD patients (at least moderate complexity) in the only tertiary congenital heart center in the territory from January 2017 to January 2019 was conducted. Orion mapping catheter in Rhythmia system (Boston Scientific) was used to create activation and voltage maps. Parameters including mechanism of arrhythmia, acute success, and follow‐up data were recorded. Results Eight patients were identified (median age 35.5 years) who underwent transcatheter ablation of atrial arrhythmia. More than one reentry circuits of IART were identified in five patients. It took a median of 32.4 minutes with 15,952 (IQR 13,395‐18,530) mapping points per map. Cavo‐annulus isthmus‐dependent mechanism was the predominant reentry mechanism. Acute success with the elimination of all inducible tachycardia was achieved in six patients (75%), and partial success in two patients. There was recurrence of atrial arrhythmia in four patients (50%), in which three patients could be maintained in sinus rhythm with low‐dose antiarrhythmic medication. Targeted substrate ablation was performed in six patients with multiple IART circuits. Critical anatomical pouches were identified in three patients, which were missed in the initial mapping using Orion basket mapping catheter. Conclusions High acute success rate of atrial arrhythmia ablation can be achieved using high‐density anatomical mapping in CHD. Substrate ablation was required with multiple IART circuits identified. Vigilance should be sought to identify anatomical pouches.

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The Electroanatomic Mechanisms of Atrial Tachycardia in Patients with Tetralogy of Fallot and Double Outlet Right Ventricle

Cited by 57 publications

References 23 publications

Late arrhythmia in patients with repaired tetralogy of Fallot: who is at risk?

Late arrhythmia in patients with repaired tetralogy of Fallot: who is at risk?

Update on Interventional Electrophysiology in Congenital Heart Disease

Missing pouches in high‐density mapping of atrial tachyarrhythmia in congenital heart diseases

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