(Circulation. 2000;102:419.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Electrophysiological Mapping and Ablation of Intra-Atrial Reentry Tachycardia After Fontan Surgery With the Use of a Noncontact Mapping System
From Wessex Cardiothoracic Center, Southampton General Hospital, UK.
Correspondence to Dr John Morgan, Consultant Cardiologist and Electrophysiologist, Wessex Cardiothoracic Center, Mailpoint 46, Southampton General Hospital, Tremona Road, Southampton, UK SO16 6YD. E-mail jmm{at}cardiology.co.uk
Background—Atrial tachyarrhythmias are a complication of Fontan surgery. Conventional electrophysiological mapping and ablation techniques are limited by the complex anatomic and surgical substrate and a high arrhythmia recurrence rate. This study investigates the use of noncontact mapping to identify arrhythmia circuits and guide ablation in Fontan patients.
Methods and Results—Eleven arrhythmias were recorded in 6 patients. Noncontact mapping improved recognition of the anatomic and surgical substrate and identified exit sites from zones of slow conduction in all clinical arrhythmias. Radiofrequency linear lesions were targeted across these critical zones in 5 patients. One patient underwent surgical cryotherapy. Although immediate success was achieved in 3 of 5 patients with radiofrequency ablation, 2 patients had a recurrence after a mean of 6.4 months of follow-up. The patient who underwent cryoablation remains free of arrhythmias.
Conclusions—Noncontact mapping can identify arrhythmia circuits in the Fontan atrium and guide placement of ablation lesions. Arrhythmia recurrence is high, possibly because of inadequate lesion creation rather than inaccurate mapping and lesion targeting.
Key Words: mapping • Fontan procedure • ablation
This article has been cited by other articles:
 |
|
 |
|
  J. E. Deanfield, R. Yates, F. J. Meijboom, and B. J.M. Mulder CHAPTER 10 Congenital Heart Disease in Children and Adults ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. J. Kanter The Fontan Right Atrium--In Context Circulation, April 3, 2007; 115(13): 1698 - 1700. [Full Text] [PDF]
|
|
|
|
 |
|
 F. Kilicaslan, A. Verma, H. Yamaji, N. F. Marrouche, O. Wazni, J. E. Cummings, S. Hao, M. W. Andrews, S. Beheiry, A. Abdul-Karim, et al. The need for atrial flutter ablation following pulmonary vein antrum isolation in patients with and without previous cardiac surgery J. Am. Coll. Cardiol., March 1, 2005; 45(5): 690 - 696. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C.-T. Tai, T.-Y. Liu, P.-C. Lee, Y.-J. Lin, M.-S. Chang, and S.-A. Chen Non-contact mapping to guide radiofrequency ablation of atypical right atrial flutter J. Am. Coll. Cardiol., September 1, 2004; 44(5): 1080 - 1086. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Verma, N. F. Marrouche, N. Seshadri, R. A. Schweikert, M. Bhargava, J. D. Burkhardt, F. Kilicaslan, J. Cummings, W. Saliba, and A. Natale Importance of ablating all potential right atrial flutter circuits in postcardiac surgery patients J. Am. Coll. Cardiol., July 21, 2004; 44(2): 409 - 414. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A.M. Sheikh, A.T.M. Tang, K. Roman, K. Baig, R. Mehta, J. Morgan, B. Keeton, J. Gnanapragasam, J.V. Vettukattil, A.P. Salmon, et al. The failing Fontan circulation: Successful conversion of atriopulmonary connections J. Thorac. Cardiovasc. Surg., July 1, 2004; 128(1): 60 - 66. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Weipert, C. Noebauer, C. Schreiber, M. Kostolny, B. Zrenner, A. Wacker, J. Hess, and R. Lange Occurrence and management of atrial arrhythmia after long-term Fontan circulation J. Thorac. Cardiovasc. Surg., February 1, 2004; 127(2): 457 - 464. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Kaulitz, G. Ziemer, T. Paul, M. Peuster, H. Bertram, and G. Hausdorf Fontan-type procedures: residual lesions and late interventions Ann. Thorac. Surg., September 1, 2002; 74(3): 778 - 785. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. J. Deal, C. Mavroudis, C. L. Backer, S. H. Buck, and C. Johnsrude Comparison of Anatomic Isthmus Block With the Modified Right Atrial Maze Procedure for Late Atrial Tachycardia in Fontan Patients Circulation, July 30, 2002; 106(5): 575 - 579. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. K. Triedman, M. E. Alexander, B. A. Love, K. K. Collins, C. I. Berul, L. M. Bevilacqua, and E. P. Walsh 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., June 5, 2002; 39(11): 1827 - 1835. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. C. Kress, D. Krum, V. Chekanov, J. Hare, N. Michaud, M. Akhtar, and J. Sra Validation of a left atrial lesion pattern for intraoperative ablation of atrial fibrillation Ann. Thorac. Surg., April 1, 2002; 73(4): 1160 - 1168. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Tritto, R. de Ponti, M. Zardini, G. Spadacini, and J. A. Salerno-Uriarte Bystander cavo-tricuspid isthmus activation during post-incisional intra-atrial reentrant tachycardia Europace, January 1, 2002; 4(1): 91 - 97. [Abstract] [PDF]
|
|
|
|
|
|
C. Mavroudis, C. L. Backer, B. J. Deal, C. Johnsrude, and J. Strasburger Total cavopulmonary conversion and maze procedure for patients with failure of the Fontan operation J. Thorac. Cardiovasc. Surg., November 1, 2001; 122(5): 863 - 871. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. G. Akar, L. C. Kok, D. E. Haines, J. P. DiMarco, and J. P. Mounsey Coexistence of type I atrial flutter and intra-atrial re-entrant tachycardia in patients with surgically corrected congenital heart disease J. Am. Coll. Cardiol., August 1, 2001; 38(2): 377 - 384. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Hindricks and H. Kottkamp Simultaneous Noncontact Mapping of Left Atrium in Patients With Paroxysmal Atrial Fibrillation Circulation, July 17, 2001; 104(3): 297 - 303. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Paul, B. Windhagen-Mahnert, T. Kriebel, H. Bertram, R. Kaulitz, T. Korte, M. Niehaus, and J. Tebbenjohanns Atrial Reentrant Tachycardia After Surgery for Congenital Heart Disease : Endocardial Mapping and Radiofrequency Catheter Ablation Using a Novel, Noncontact Mapping System Circulation, May 8, 2001; 103(18): 2266 - 2271. [Abstract] [Full Text] [PDF]
|
|