Mechanisms and predictors of recurrent tachycardia after catheter ablation for d-transposition of the great arteries after the Mustard or Senning operation

Repeat radiofrequency catheter ablation of atrial tachycardias in patients with congenital heart disease

“…These findings are in accordance with previous reports that AT in a substantial part of CHD patients may not be “cured” during a single procedure 7,15 and should be discussed with patients when informed consent is obtained. In accordance with findings on catheter ablation in patients with CHD and the role of CHD complexity, 6 subjects after atrial switch procedures for d ‐transposition of the great arteries and patients with a Fontan circulation were most prone to require multiple repeat ablation procedures during follow‐up 8,21,22 . In general, however, the complexity of CHD was not associated with the initial success and number of repeat ablation procedures.…”

“…cCHD, complex congenital heart disease; mCHD, moderate congenital heart disease; sCHD, simple congenital heart disease with CHD and the role of CHD complexity, 6 subjects after atrial switch procedures for D-transposition of the great arteries and patients with a Fontan circulation were most prone to require multiple repeat ablation procedures during follow-up. 8,21,22 In general, however, the complexity of CHD was not associated with the initial success and number of repeat ablation procedures. Classifying the complexity of CHD according to the current recommendation 10 was therefore not a good predictor for the outcome.…”

Atrial flutter catheter ablation in adult congenital heart diseases

“…Contrast angiography via a pigtail catheter is sometimes performed in some centers to provide a greater degree of anatomic detail and to reveal potential baffle obstructions or shunts. While cavotricuspid isthmus-dependent flutters are also by far the main mechanism observed in those patients [ [13] , [14] , [15] ], it is actually partitioned in two with the tricuspid valve on the pulmonary venous side and inferior vena cava on the systemic venous side [ 16 ]. The relative proportion of the isthmus on each side of the circulation depends on the surgical variant but imposes ablation in both atria after transbaffle puncture or via retrograde approach.…”

“…Despite these anatomical features, complete cavotricuspid isthmus block is usually achieved in most patients without particular difficulty. Other IART encountered are relatively heterogeneous and include circuits around the atriotomy or the posterior anastomosis (vertical atrial incision adjacent to the right pulmonary veins along the interatrial groove done during Senning surgery to channelise blood from the pulmonary veins around the baffle to the pulmonary venous atrium) in the pulmonary venous atrium [ 15 ]. Examples of cavotricuspid isthmus-dependent atrial flutter catheter ablation by transbaffle puncture (video 1) or retrograde aortic approach (video 2) are provided as supplementary material.…”

Fluoroless Rapid Mapping and Catheter Ablation of Intra-atrial Reentry Tachycardia in a Patient with Mustard Operation Using the Ensite™ Precision™ Electroanatomic Mapping System

“…[1][2][3] To date, the incidence and recurrence after catheter ablation of atrial arrhythmias in adult Mustard and Senning patients remains high. [4][5][6][7][8][9] Fluoroless catheter ablation of atrioventricular nodal reentrant tachycardia in a Mustard patient using threedimensional (3D) electroanatomic mapping was recently reported. 10 This current paper describes the first use of the EnSitet Precisiont cardiac mapping system (Abbott Laboratories, Chicago, IL, USA) to allow for rapid mapping and to aid in fluoroless catheter ablation of intra-atrial reentry tachycardia (IART) in an adult patient with Mustard palliation.…”