#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Catheter ablation of postincisional tachycardias: final solution or palliative treatment?


Authors: P. Peichl
Authors‘ workplace: Klinika kardiologie IKEM, Praha
Published in: Kardiol Rev Int Med 2006, 8(Supplementum): 33-36

Overview

Patients after surgical correction of congenital heart disease and/or valve surgery are at risk of postincisional tachycardias. Scar tissue after the surgery creates a complex arrhythmogenic substrate for multiple reentrant tachycardias. In patients after right and/or left atriotomy, the impulse circulates around the postatriotomy scar. In case of Fontane procedure, the right atrium is usually dilatated with extensive scarring and variable reentry circuits. Patients after atrial correction of transposition of great arteries most commonly develop reentry around tricuspid annulus, however, the access to both atria is difficult. Ventricular postincisional tachycardias are usually associated with postventriculotomy scar. In principle, catheter ablation consists of interruption of reentry circuit by ablation line from the central obstacle to the neighboring anatomical barrier. To prevent of all forms of reentrant circuits, it is necessary to abolish all potential channels of slow conduction within the scar area. Modern electrophysiologic mapping systems enable exact characterization of the arrhythmogenic substrate and precise identification of target for radiofrequency ablation.

Key words:
catheter ablation - congenital heart disease - incisional tachycardias


Sources

1. Garson A Jr, Bink-Boelkens M, Hesslein PS et al. Atrial flutter in the young: a collaborative study of 380 cases. J Am Coll Cardiol 1985; 6: 871-878.

2. Markowitz SM, Brodman RF, Stein KM et al. Lesional tachycardias related to mitral valve surgery. J Am Coll Cardiol 2002; 39: 1973-1983.

3. 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.

4. Delacretaz E, Ganz LI, Soejima K et al. Multi atrial maco-re-entry circuits in adults with repaired congenital heart disease: entrainment mapping combined with three-dimensional electroanatomic mapping. J Am Coll Cardiol 2001; 37: 1665-1676.

5. Dorostkar PC, Cheng J, Scheinman MM. Electroanatomical mapping and ablation of the substrate supporting intraatrial reentrant tachycardia after palliation for complex congenital heart disease. Pacing Clin Electrophysiol 1998; 21(9): 1810-1819.

6. Peichl P, Kautzner J, Cihak R et al. Clinical application of electroanatomical mapping in the characterization of "incisional" atrial tachycardias. Pacing Clin Electrophysiol 2003; 26(1,2): 420-425.

7. Triedman JK, Alexander ME, Berul CI et al. Electroanatomic mapping of entrained and exit zones in patients with repaired congenital heart disease and intra-atrial reentrant tachycardia. Circulation 2001; 103: 2060-2065.

8. Shah D, Jais P, Takahashi A et al. Dual-loop intra-atrial reentry in humans. Circulation 2000; 101: 631-639.

9. Tomita Y, Matsuo K, Sahadevan J et al. Role of functional block extension in lesion-related atrial flutter. Circulation 2001; 103: 1025-1030.

10. Collins KK, Love BA, Walsh EP et al. Location of acutely successful radiofrequency catheter ablation of intraatrial reentrant tachycardia in patients with congenital heart disease. Am J Cardiol 2000; 86: 969-974.

11. Zrenner B, Dong J, Schreieck J et al. Delineation of intra-atrial reentrant tachycardia circuits after mustard operation for transposition of the great arteries using biatrial electroanatomic mapping and entrainment mapping. J Cardiovasc Electrophysiol 2003; 14: 1302-1310.

12. Kalman JM, VanHare GF, Olgin JE et al. 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: 502-512.

13. Triedman JK, Jenkins KJ, Colan SD et al. Intra-atrial reentrant tachycardia after palliation of congenital heart disease: characterization of multiple macroreentrant circuits using fluoroscopically based three-dimensional endocardial mapping. J Cardiovasc Electrophysiol 1997; 8: 259-270.

14. Baker BM, Lindsay BD, Bromberg BI et al. Catheter ablation of clinical intraatrial reentrant tachycardias resulting from previous atrial surgery: localizing and transecting the critical isthmus. J Am Coll Cardiol 1996; 28: 411-417.

15. Paul T, Windhagen-Mahnert B, Kriebel T et al. Atrial reentrant tachycardia after surgery for congenital heart disease: endocardial mapping and radiofrequency catheter ablation using a novel, noncontact mapping system. Circulation 2001; 103: 2266-2271.

16. Love BA, Collins KK, Walsh EP et al. Electroanatomic characterization of conduction barriers in sinus/atrially paced rhythm and association with intra-atrial reentrant tachycardia circuits following congenital heart disease surgery. J Cardiovasc Electrophysiol 2001; 12: 17-25.

17. Henglein D, Cauchemez B, Bloch G. Simultaneous surgical treatment of atrial septal defect and atrial flutter using a simple modification of the atrial incision. Cardiol Young 1999; 9: 197-199.

18. Collins KK, Rhee EK, Delucca JM et al. Modification to the Fontan procedure for the prophylaxis of intra-atrial reentrant tachycardia: short-term results of a prospective randomized blinded trial. J Thorac Cardiovasc Surg 2004; 127: 721-729.

19. 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: 975-981.

20. Harrison DA, Harris L, Siu SC et al. Sustained ventricular tachycardia in adult patients late after repair of tetralogy of Fallot. J Am Coll Cardiol 1997; 30: 1368-1373.

21. Gonska BDM, Cao KM, Raab JM et al. Heart Disease in the Young: Radiofrequency Catheter Ablation of Right Ventricular Tachycardia Late After Repair of Congenital Heart Defects. Circulation 1996; 94: 1902-1908.

22. Stevenson WG, Delacretaz E, Friedman PL et al. Identification and ablation of macroreentrant ventricular tachycardia with the CARTO electroanatomical mapping system. Pacing Clin Electrophysiol 1998; 21(7): 1448-56.

23. Rostock T, Willems S, Ventura R et al. Radiofrequency catheter ablation of a macroreentrant ventricular tachycardia late after surgical repair of tetralogy of Fallot using the electroanatomic mapping (CARTO). Pacing Clin Electrophysiol 2004; 27(6,1): 801-4.

24. Alexander ME, Walsh EP, Saul JP et al. Value of programmed ventricular stimulation in patients with congenital heart disease. J Cardiovasc Electrophysiol 1999; 10: 1033-1044.

Labels
Paediatric cardiology Internal medicine Cardiac surgery Cardiology
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#