Abstract
Macroreentrant atrial tachycardia is a common complication following surgery for congenital heart disease (CHD), and is often highly symptomatic with potentially significant hamodynamic consequences. Medical management is often unsuccessful, requiring the use of invasive procedures. Cavotricuspid isthmus dependent flutter is the most common circuit but atypical circuits also exist, involving sites of surgical intervention or areas of scar related to abnormal hemodynamics. Ablation can be technically challenging, due to complex anatomy, and difficulty with catheter stability. A thorough assessment of the patients status and pre-catheter ablation planning is critical to successfully managing these patients.
Keywords: Congenital heart disease, supraventricular tachycardia, catheter ablation.
Graphical Abstract
[1]
Hoffman JIE, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol 2002; 39: 1890-900.
[2]
Kanter RJ, Papagiannis J, Carboni MP, Ungerleider RM, Sanders WE, Wharton JM. Radiofrequency catheter ablation of supraventricular tachycardia substrates after mustard and senning operations for d-transposition of the great arteries. J Am Coll Cardiol 2000; 35: 428-41.
[3]
Bae E-J, Noh C-I, Choi J-Y, et al. Late occurrence of adenosine-sensitive focal junctional tachycardia in complex congenital heart disease. J Interv Card Electrophysiol 2005; 12: 115-22.
[4]
Saoudi N, Cosío F, Waldo A, et al. A classification of atrial flutter and regular atrial tachycardia according to electrophysiological mechanisms and anatomical bases; a Statement from a Joint Expert Group from The Working Group of Arrhythmias of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Eur Heart J 2001; 22: 1162-82.
[5]
Triedman JK, Saul JP, Weindling SN, Walsh EP. Radiofrequency ablation of intra-atrial reentrant tachycardia after surgical palliation of congenital heart disease. Circulation 1995; 91: 707-14.
[6]
Haines DE, DiMarco JP. Sustained intraatrial reentrant tachycardia: clinical, electrocardiographic and electrophysiologic characteristics and long-term follow-up. J Am Coll Cardiol 1990; 15: 1345-54.
[7]
Wells R, Khairy P, Harris L, Anderson CC, Balaji S. Dofetilide for atrial arrhythmias in congenital heart disease: a multicenter study. Pacing Clin Electrophysiol 2009; 32: 1313-8.
[8]
Feltes TF, Friedman RA. Transesophageal echocardiographic detection of atrial thrombi in patients with nonfibrillation atrial tachyarrhythmias and congenital heart disease. J Am Coll Cardiol 1994; 24: 1365-70.
[9]
Garson A, Bink-Boelkens M, Hesslein PS, et al. Atrial flutter in the young: a collaborative study of 380 cases. J Am Coll Cardiol 1985; 6: 871-8.
[10]
Yap S-C, Harris L, Silversides CK, Downar E, Chauhan VS. Outcome of intra-atrial re-entrant tachycardia catheter ablation in adults with congenital heart disease: negative impact of age and complex atrial surgery. J Am Coll Cardiol 2010; 56: 1589-96.
[11]
Triedman JK, Alexander ME, Love BA, et al. Influence of patient factors and ablative technologies on outcomes of radiofrequency ablation of intra-atrial re-entrant tachycardia in patients with congenital heart disease. J Am Coll Cardiol 2002; 39: 1827-35.
[12]
Wu J, Pflaumer A, Deisenhofer I, et al. Mapping of intraatrial reentrant tachycardias by remote magnetic navigation in patients with d-transposition of the great arteries after mustard or senning procedure. J Cardiovasc Electrophysiol 2008; 19: 1153-9.
[13]
Ernst S, Babu-Narayan SV, Keegan J, et al. Remote-controlled magnetic navigation and ablation with 3D image integration as an alternative approach in patients with intra-atrial baffle anatomy. Circ Arrhythm Electrophysiol 2012; 5: 131-9.
[14]
Rhodes LA, Walsh EP, Gamble WJ, Triedman JK, Saul JP. Benefits and potential risks of atrial antitachycardia pacing after repair of congenital heart disease. Pacing Clin Electrophysiol 1995; 18: 1005-16.
[15]
Mavroudis C, Backer CL, Deal BJ, Johnsrude C, Strasburger J. Total cavopulmonary conversion and maze procedure for patients with failure of the Fontan operation. J Thorac Cardiovasc Surg 2001; 122: 863-71.
[16]
Marcelletti CF, Hanley FL, Mavroudis C, et al. Revision of previous Fontan connections to total extracardiac cavopulmonary anastomosis: A multicenter experience. J Thorac Cardiovasc Surg 2000; 119: 340-6.
[17]
Bink-Boelkens MT, Velvis H, van der Heide JJ, Eygelaar A, Hardjowijono RA. Dysrhythmias after atrial surgery in children. Am Heart J 1983; 106: 125-30.
[18]
Roos-Hesselink JW, Meijboom FJ, Spitaels SEC, et al. Excellent survival and low incidence of arrhythmias, stroke and heart failure long-term after surgical ASD closure at young age. A prospective follow-up study of 21-33 years. Eur Heart J 2003; 24: 190-7.
[19]
Morton JB, Sanders P, Vohra JK, et al. Effect of chronic right atrial stretch on atrial electrical remodeling in patients with an atrial septal defect. Circulation 2003; 107: 1775-82.
[20]
Roberts-Thomson KC, John B, Worthley SG, et al. Left atrial remodeling in patients with atrial septal defects. Heart Rhythm 2009; 6: 1000-6.
[21]
Vecht JA, Saso S, Rao C, et al. Atrial septal defect closure is associated with a reduced prevalence of atrial tachyarrhythmia in the short to medium term: a systematic review and meta-analysis. Heart 2010; 96: 1789-97.
[22]
Silversides CK, Siu SC, McLaughlin PR, et al. Symptomatic atrial arrhythmias and transcatheter closure of atrial septal defects in adult patients. Heart 2004; 90: 1194-8.
[23]
Gatzoulis MA, Freeman MA, Siu SC, Webb GD, Harris L. Atrial arrhythmia after surgical closure of atrial septal defects in adults. N Engl J Med 1999; 340: 839-46.
[24]
Akar JG, Kok LC, Haines DE, DiMarco JP, Mounsey JP. Coexistence of type I atrial flutter and intra-atrial re-entrant tachycardia in patients with surgically corrected congenital heart disease. J Am Coll Cardiol 2001; 38: 377-84.
[25]
Shah D, Jaïs P, Takahashi A, et al. Dual-loop intra-atrial reentry in humans. Circulation 2000; 101: 631-9.
[26]
Magnin-Poull I, De Chillou C, Miljoen H, Andronache M, Aliot E. Mechanisms of right atrial tachycardia occurring late after surgical closure of atrial septal defects. J Cardiovasc Electrophysiol 2005; 16: 681-7.
[27]
Snowdon RL, Balasubramaniam R, Teh AW, et al. Linear ablation of right atrial free wall flutter: demonstration of bidirectional conduction block as an endpoint associated with long-term success. J Cardiovasc Electrophysiol 2010; 21: 526-31.
[28]
Gatzoulis MA, Balaji S, Webber SA, et al. Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multicentre study. Lancet 2000; 356: 975-81.
[29]
Khairy P, Aboulhosn J, Gurvitz MZ, et al. Arrhythmia burden in adults with surgically repaired tetralogy of Fallot: a multi-institutional study. Circulation 2010; 122: 868-75.
[30]
Roos-Hesselink J, Perlroth MG, McGhie J, Spitaels S. Atrial arrhythmias in adults after repair of tetralogy of Fallot. Correlations with clinical, exercise, and echocardiographic findings. Circulation 1995; 91: 2214-9.
[31]
Nakagawa H, Shah N, Matsudaira K, et al. Characterization of reentrant circuit in macroreentrant right atrial tachycardia after surgical repair of congenital heart disease: isolated channels between scars allow “focal” ablation. Circulation 2001; 103: 699-709.
[32]
Chan DP, Van Hare GF, Mackall JA, Carlson MD, Waldo AL. Importance of atrial flutter isthmus in postoperative intra-atrial reentrant tachycardia. Circulation 2000; 102: 1283-9.
[33]
Roten L, Lukac PDE, Groot N, et al. Catheter ablation of arrhythmias in ebstein’s anomaly: a multicenter study. J Cardiovasc Electrophysiol 2011; 22: 1391-6.
[34]
Flinn CJ, Wolff GS, Dick M, et al. Cardiac rhythm after the Mustard operation for complete transposition of the great arteries. N Engl J Med 1984; 310: 1635-8.
[35]
Durongpisitkul K, Porter CJ, Cetta F, et al. Predictors of early- and late-onset supraventricular tachyarrhythmias after Fontan operation. Circulation 1998; 98: 1099-107.
[36]
Collins KK, Love BA, Walsh EP, Saul JP, Epstein MR, Triedman JK. Location of acutely successful radiofrequency catheter ablation of intraatrial reentrant tachycardia in patients with congenital heart disease. Am J Cardiol 2000; 86: 969-74.
[37]
Kalman JM, VanHare GF, Olgin JE, Saxon LA, Stark SI, Lesh MD. Ablation of “incisional” reentrant atrial tachycardia complicating surgery for congenital heart disease. Use of entrainment to define a critical isthmus of conduction. Circulation 1996; 93: 502-12.
[38]
Gelatt M, Hamilton RM, McCrindle BW, et al. Risk factors for atrial tachyarrhythmias after the Fontan operation. J Am Coll Cardiol 1994; 24: 1735-41.
[39]
Takahashi K, Fynn-Thompson F, Cecchin F, Khairy P, del Nido P, Triedman JK. Clinical outcomes of Fontan conversion surgery with and without associated arrhythmia intervention. Int J Cardiol 2009; 137: 260-6.
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