Elsevier

Heart Rhythm

Volume 1, Issue 3, September 2004, Pages 268-275
Heart Rhythm

Irrigated-tip catheter ablation of intraatrial reentrant tachycardia in patients late after surgery of congenital heart disease

https://doi.org/10.1016/j.hrthm.2004.04.020Get rights and content

Objectives

The aim of this study was to evaluate irrigated-tip catheter for ablation of intraatrial reentrant tachycardias late after surgical repair of congenital heart disease.

Background

In congenital heart disease patients, the right atrium can be markedly enlarged with areas of low blood flow. Radiofrequency (RF) lesion creation may be hampered by insufficient electrode cooling at sites with low blood flow.

Methods

Thirty-six consecutive patients with intraatrial reentrant tachycardia refractory to antiarrhythmic therapy from two centers were included in the study. Entrainment pacing and electroanatomic mapping (CARTO®) were used to delineate reentrant circuits and critical isthmus sites. RF ablation was performed using an irrigated-tip catheter (Navistar Thermocool®).

Results

Fifty-two intraatrial reentrant tachycardia circuits were identified, and 48 were targeted with RF ablation. RF ablation was performed using a mean of 13 ± 11 irrigated RF applications per tachycardia isthmus with a mean power of 36 ± 8 W. In a historical control group of congenital heart disease patients managed with conventional catheter ablation, the number of lesions per isthmus was higher (23 ± 11) and mean power was lower (27 ± 14 W). Acute success was achieved in 45 intraatrial reentrant tachycardias (94% of targeted tachycardias and 87% of all tachycardias). After a mean follow-up of 17 ± 7 months, 33 (92%) of 36 patients were free of recurrence. Five patients (14%) developed paroxysmal atrial fibrillation.

Conclusions

The combination of modern techniques including electroanatomic mapping and catheter irrigation allows safe and highly effective ablation of intraatrial reentrant tachycardia in patients with surgically repaired congenital heart disease.

Section snippets

Patient population

The study group consisted of 36 consecutive patients referred to the Swiss Cardiovascular Center Bern and to the Department of Cardiology, Aarhus University Hospital (Skejby), Denmark, for management of intraatrial reentrant tachycardia late after surgery for congenital heart disease. All patients had symptomatic persistent or recurrent intraatrial reentrant tachycardia refractory to antiarrhythmic drug therapy. Patients with predominant atrial fibrillation were excluded from the study. All

Patient characteristics

Thirty-six consecutive patients (26 male [72%]; median age 46 years, range 9–67) with surgically corrected congenital heart disease were studied (Table 1). Cardiac anomalies included tetralogy of Fallot (TOF, n = 8), atrial septal defect (ASD, primum, n = 5; secundum, n = 14), transposition of the great vessels (n = 5), ventricular septal defect (VSD, n = 1), univentricular heart (n = 1), and congenitally corrected transposition of the great vessels with VSD (n = 1). The functional status of

Discussion

This study presents initial experience combining recent advances in electroanatomic mapping with traditional entrainment mapping and lesion formation using irrigated-tip catheters.

Conclusion

Electronanatomic mapping and entrainment mapping allow precise characterization of complex reentrant circuits. Adding catheter irrigation to these mapping techniques allows increased power delivery, particularly to sites with low blood flow. This approach is safe and highly effective for ablation of both typical isthmus-dependent atrial flutter and incisional atrial tachycardia in congenital heart disease patients. The combination of entrainment mapping, electroanatomic mapping, and

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Dr. Lukac was supported by a Training Fellowship from the European Society of Cardiology and a Training Fellowship from the Slovak Society of Cardiology. Dr. Delacretaz was supported by Grant 632-066101 from the Swiss National Research Foundation.

H.T. and P.L. contributed equally to the manuscript.

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