Catheter Ablation of Atrial Arrhythmias in Patients Post-Fontan

Kamp, Anna; Nair, Krishnakumar; Fish, Frank A.; Khairy, Paul

doi:10.1016/j.cjca.2022.02.023

Cited by 9 publications

(8 citation statements)

References 49 publications

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“… 81 , 82 The fact that even patients with extracardiac conduits develop AF implies that mechanisms such as preprocedural, hypoxemia‐induced, structural, and functional changes, as well as autonomic dysfunction may also play a proarrhythmogenic role. 83 …”

Section: Achd Forms Treated With Af Ablationmentioning

confidence: 99%

“… 86 In the setting of total cavopulmonary connections, ablation can be accomplished by penetrating an existing patent fenestration or by performing a transcaval or transconduit puncture. 83 The transcaval access includes perforating a site of overlap between the inferior vena cava and the pulmonary venous atrial wall. This approach has proven feasible in patients with extracardiac conduits and sufficient cavoatrial overlap (>3 mm).…”

Section: Achd Forms Treated With Af Ablationmentioning

confidence: 99%

“… 88 In case conduit crossing is impossible because of large‐scale calcifications, 87 , 88 the pulmonary venous atrium can be reached via a retrograde aortic route with the use of magnetic navigation system. 83 , 89 However, this approach seems to be intricate, too. Potential difficulties include transversing the systemic semilunar and atrioventricular valve and catheter handling in the tortuous retrograde aortic course.…”

Section: Achd Forms Treated With Af Ablationmentioning

confidence: 99%

“… 98 , 99 In contrast, progressive atrial cardiomyopathy has been proposed as a possible responsible mechanism for the new AF episodes in patients with Fontan circulation. 83 , 98 , 99 …”

Section: Achd Forms Treated With Af Ablationmentioning

confidence: 99%

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Atrial Fibrillation Ablation in Congenital Heart Disease: Therapeutic Challenges and Future Perspectives

Baroutidou,

Otountzidis,

Papazoglou

et al. 2024

JAHA

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The increasing prevalence of atrial fibrillation (AF) in adults with congenital heart disease raises significant questions regarding its management. The unique underlying anatomic and physiological background further adds to the difficulty in eliminating the AF burden in these patients. Herein, we provide an overview of the current knowledge on the pathophysiology and risk factors for AF in adult congenital heart disease, with a special focus on the existing challenges in AF ablation. Emerging imaging modalities and ablation techniques might have a role to play. Evidence regarding the safety and efficacy of AF ablation in adult congenital heart disease is summarized, especially for patients with an atrial septal defect, Ebstein anomaly of the tricuspid valve, tetralogy of Fallot, and Fontan circulation. Finally, any remaining gaps in knowledge and potential areas of future research are highlighted.

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Section: Achd Forms Treated With Af Ablationmentioning

confidence: 99%

Section: Achd Forms Treated With Af Ablationmentioning

confidence: 99%

Section: Achd Forms Treated With Af Ablationmentioning

confidence: 99%

“… 98 , 99 In contrast, progressive atrial cardiomyopathy has been proposed as a possible responsible mechanism for the new AF episodes in patients with Fontan circulation. 83 , 98 , 99 …”

Section: Achd Forms Treated With Af Ablationmentioning

confidence: 99%

See 2 more Smart Citations

Atrial Fibrillation Ablation in Congenital Heart Disease: Therapeutic Challenges and Future Perspectives

Baroutidou,

Otountzidis,

Papazoglou

et al. 2024

JAHA

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“…Individual patient anatomy and multiplicity of demonstrated arrhythmias contribute to the complexity and anticipated success of the procedure. Challenges to catheter ablation in adult patients with Fontan palliation include catheter access to the arrhythmia substrate, as with extracardiac Fontan anatomy in which access to atrial tissue involves trans-baffle puncture of extracardiac conduit, the difficult location and fragility of the intrinsic conduction system, and the existence of multiple or complex arrhythmias [ 13 , 54 ]. Additionally, vascular access may complicate any attempt at ablation procedure, as with patients with heterotaxy who have interrupted IVC, or those patients with venous occlusions.…”

Section: Long-term Management Of Atrial Arrhythmiasmentioning

confidence: 99%

Atrial Arrhythmias in Adults with Fontan Palliation

Laubham,

Blais,

Kamp

2023

Cardiol Ther

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Single ventricle physiology is a rare form of congenital heart disease and was, historically, a uniformly lethal condition. However, the atriopulmonary Fontan operation, and its successive iterations, the lateral tunnel and extracardiac conduit Fontan, became the fundamental approach to treating single ventricle heart disease. Over time, dysrhythmias are some of the most common complications with Fontan physiology, compounding morbidity and mortality. Atrial arrhythmias are prevalent in the Fontan population and occur in about 15–60% of patients with Fontan palliation, increasingly with age. Diagnosing atrial arrhythmias in patients with Fontan palliation may be challenging because of low voltage amplitudes arising from myopathic atrial tissue making it difficult to clearly assess atrial depolarization on surface electrocardiograms (ECG), vague symptoms not suggestive of tachyarrhythmia, or atrial arrhythmia with ventricular rates below 100 beats per minute. Intra-atrial reentrant tachycardia (IART) is the most common type of supraventricular tachycardia in adults with Fontan palliation. Acute management of atrial arrhythmias in patients with Fontan palliation involves prompt assessment of a patient’s hemodynamic stability, anticoagulation and thrombosis risk, systemic ventricular function, and risk of sedation or anesthesia if needed. Long-term management of atrial arrhythmias is often multifactorial and may include long-term anti-arrhythmic therapy, permanent pacing, and ablation. The best approach for the management of atrial arrhythmias in adults with Fontan palliation is patient-specific and involves collaboration between congenital electrophysiologists, adult congenital cardiologists, and the patient.

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