Intra-atrial re-entrant tachycardia in congenital heart disease: types and relation of isthmus to atrial voltage

Roca‐Luque, Ivo; Rivas-Gándara, Núria; Subirà, Laura Dos; Francisco‐Pascual, Jaume; Pijuan-Domenech, Antònia; Pérez-Rodón, Jordi; Subirana, M; Ortega, A Santos; Miranda, Berta; Rosés‐Noguer, Ferran; Ferreira‐González, Ignacio; Ferrer, Jaume; García, David García‐Dorado; Mitjans, Àngel Moya

doi:10.1093/europace/eux250

Cited by 21 publications

(23 citation statements)

References 39 publications

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“…Entrainment and concealed fusion could be studied in 95.7% of the patients. Areas of scar were delineated from peak‐to‐peak amplitude of a bipolar electrogram, using a cut‐off value of 0.5 mV . During ablation, temperature and power were limited to 43°C and 30 to 40 W for irrigated‐tip catheter (81% of the procedures) and 60°C to 70°C and 60 to 70 W for no cooled catheter.…”

Section: Methodsmentioning

confidence: 99%

“…Areas of scar were delineated from peak-to-peak amplitude of a bipolar electrogram, using a cut-off value of 0.5 mV. 30 During ablation, temperature and power were limited to 43°C and 30 to 40 W for irrigated-tip catheter (81% of the procedures) and 60°C to 70°C and 60 to 70 W for no cooled catheter. Ablation success was defined as termination of IART and noninducibility of any kind of IART for all patients.…”

Section: Electrophysiological Studymentioning

confidence: 99%

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Predictors of Acute Failure Ablation of Intra‐atrial Re‐entrant Tachycardia in Patients With Congenital Heart Disease: Cardiac Disease, Atypical Flutter, and Previous Atrial Fibrillation

Roca‐Luque

Rivas-Gándara

Dos‐Subirà

et al. 2018

JAHA

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BackgroundIntra‐atrial re‐entrant tachycardia (IART) in patients with congenital heart disease (CHD) increases morbidity and mortality. Radiofrequency catheter ablation has evolved as the first‐line treatment. The aim of this study was to analyze the acute success and to identify predictors of failed IART radiofrequency catheter ablation in CHD.Methods and ResultsThe observational study included all consecutive patients with CHD who underwent a first ablation procedure for IART at a single center from January 2009 to December 2015 (94 patients, 39.4% female, age: 36.55±14.9 years). In the first procedure, 114 IART were ablated (acute success: 74.6%; 1.21±0.41 IART per patient) with an acute success of 74.5%. Cavotricuspid isthmus–related IART was the only arrhythmia in 51%; non–cavotricuspid isthmus–related IART was the only mechanism in 27.7% and 21.3% of the patients had both types of IART. Predictors of acute radiofrequency catheter ablation failure were as follows: nonrelated cavotricuspid isthmus IART (odds ratio 7.3; confidence interval [CI], 1.9–17.9; P=0.04), previous atrial fibrillation (odds ratio 6.1; CI, 1.3–18.4; P=0.02), transposition of great arteries (odds ratio, 4.9; CI, 1.4–17.2; P=0.01) and systemic ventricle dilation (odds ratio 4.8; CI, 1.1–21.7; P=0.04) with an area under the receiver operating characteristic curve of 0.83±0.056 (CI, 0.74–0.93, P=0.001). After a mean follow‐up longer than 3.5 years, 78.3% of the patients were in sinus rhythm (33.1% of the patients required more than 1 radiofrequency catheter ablation procedure).ConclusionsAlthough ablation in CHD is a challenging procedure, acute success of 75% can be achieved in moderate–highly complex CHD patients in a referral center. Predictors of failed ablation are IART different from cavotricuspid isthmus, previous atrial fibrillation, and markers of complex CHD (transposition of great arteries, systemic ventricle dilation).

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Section: Methodsmentioning

confidence: 99%

Section: Electrophysiological Studymentioning

confidence: 99%

Predictors of Acute Failure Ablation of Intra‐atrial Re‐entrant Tachycardia in Patients With Congenital Heart Disease: Cardiac Disease, Atypical Flutter, and Previous Atrial Fibrillation

Roca‐Luque

Rivas-Gándara

Dos‐Subirà

et al. 2018

JAHA

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“…Our cohort demonstrated the comparable of atrial tachyarrhythmia mechanisms in CHD, with predominant IART through the cavo‐annular (cavo‐tricuspid) isthmus. In cases of non‐CTI‐related IART, the most frequent location of IART isthmus was the lateral or posterolateral wall of the venous atria . Recurrent circuits around caval orifices, crista terminalis, or the atrial appendage are also observed, but less frequently .…”

Section: Discussionmentioning

confidence: 99%

“…In the study of Roca‐Luque et al, a cut‐off voltage of 0.5 mV could identify 95.4% of the substrates in non‐CTI‐related IART . Unexcitable sites can be displayed together with the caval veins, valve annuli, and lines of double potentials.…”

Section: Discussionmentioning

confidence: 99%

“…of non-CTI-related IART, the most frequent location of IART isthmus was the lateral or posterolateral wall of the venous atria. [10][11][12] Recurrent circuits around caval orifices, crista terminalis, or the atrial appendage are also observed, but less frequently. 13 We also demonstrated that multiple IARTs can be induced in a single patient, each requiring individual mapping and ablation.…”

Section: Re Sultsmentioning

confidence: 99%

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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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Lateral tunnel Fontan atrial tachycardia ablation trans-baffle access is not mandatory as the initial strategy

Bhaskaran

Nayyar

Charla

et al. 2019

J Interv Card Electrophysiol

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Intra-atrial re-entrant tachycardia in congenital heart disease: types and relation of isthmus to atrial voltage

Cited by 21 publications

References 39 publications

Predictors of Acute Failure Ablation of Intra‐atrial Re‐entrant Tachycardia in Patients With Congenital Heart Disease: Cardiac Disease, Atypical Flutter, and Previous Atrial Fibrillation

Predictors of Acute Failure Ablation of Intra‐atrial Re‐entrant Tachycardia in Patients With Congenital Heart Disease: Cardiac Disease, Atypical Flutter, and Previous Atrial Fibrillation

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

Lateral tunnel Fontan atrial tachycardia ablation trans-baffle access is not mandatory as the initial strategy

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