Catheter ablation of supraventricular tachycardia after tricuspid valve surgery in patients with congenital heart disease: A multicenter comparative study

Right-sided Atrial Flutter Ablation after Tricuspid Valve-in-Valve Replacement

“…On the one hand this is a consequence of surgical incisions resulting in fibrosed areas of slow electrical conduction, but also occur secondary due to altered haemodynamics associated with the causative valvular pathology. The most common arrhythmias after TV surgery were found to be CTI dependent arrhythmias in a large cohort of adult congenital heart disease (ACHD) patients [1]. CTI…”

“…Keywords: Atrial flutter; electroanatomical mapping; ablation; transcatheter tricuspid valve-in-valve replacement ablation with radiofrequency energy is known to be a highly effective and safe procedure [2]. However, CTI ablation in patients after prosthetic TV replacement can be technically challenging due to a portion of the atrial myocardium participating in the reentry circuit potentially being covered by prosthetic material, thus remaining inaccessible for ablation [1]. Moreover, there is concern that the sewing ring near the annulus might generate an anatomical obstacle for linear ablation [3,4].…”

“…A larger case series of CTI ablation in ACHD patients with prosthetic TV or tricuspid annuloplasty ring demonstrated, that atrial tissue critical to the arrhythmia may require ablation from the ventricular side of the prosthesis without damage to the valve and good short-term outcomes [9]. In contrast to the case reports, the largest case series so far, involving several experienced ACHD centres systematically investigating the impact of TV surgery on catheter ablation outcomes, found, that catheter ablation success was lower and tachycardia recurrence was higher after TV ring/replacement surgery compared to patients without prior TV surgery or with TV repair only [1]. In addition, procedures after TV surgery were longer and required greater fluoroscopy exposure and energy delivery.…”

Atrial flutter catheter ablation in adult congenital heart diseases

“…Furthermore, the potential risk of damaging the prosthetic valve must be considered. A recent multicenter study including patients with CHD demonstrated that the acute success for annular substrates was lower in patients with tricuspid valve replacement or ring (73%) compared to patients with tricuspid valve repair (92%) and to patients with no surgery (94%) [ 40 ]. Another study demonstrated that ablation on the ventricular size of the prosthesis may be required in a significant proportion of cases to achieve cavotricuspid isthmus bidirectional block ( Fig.…”

Before it is too late: pre-emptive ablation strategies in tetralogy of Fallot

“… 13 Consider also the use of pre-operative EP assessment and pre-emptive catheter ablation of latent substrates in Ebstein malformation of the tricuspid valve before tricuspid valve replacement. 14 This approach is deemed advisable due to concerns that tricuspid valve intervention may render arrhythmia substrates inaccessible and compromise the efficacy of catheter ablation. These examples reinforce the value of proactive strategies in identifying and eliminating arrhythmia conditions before they become problematic.…”