(Circulation. 2001;103:699.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Characterization of Reentrant Circuit in Macroreentrant Right Atrial Tachycardia After Surgical Repair of Congenital Heart Disease
Isolated Channels Between Scars Allow "Focal" Ablation
From the Cardiac Arrhythmia Research Institute, University of Oklahoma Health Sciences Center, Oklahoma City.
Correspondence to Hiroshi Nakagawa, MD, PhD, Cardiac Arrhythmia Research Institute, 1200 Everett Dr (TUH-6E 103), Oklahoma City, OK 73104. E-mail hiroshi-nakagawa{at}ouhsc.edu
Background—The purpose of this study was to characterize the circuit of macroreentrant right atrial tachycardia (MacroAT) in patients after surgical repair of congenital heart disease (SR-CHD).
Methods and
Results—Sixteen patients with atrial
tachycardia (AT) after SR-CHD were studied (atrial septal defect in 6,
tetralogy of Fallot in 4, and Fontan procedure in 6). Electroanatomic
right atrial maps were obtained during 15 MacroATs in 13 patients,
focal AT in 1 patient, and atrial pacing in 2 patients without stable
AT. A large area of low bipolar voltage (
0.5 mV) involved most of the
free wall in all patients and contained 2 to 7 dense scars or lines of
double potentials, forming 29 narrow channels (width 2.7 cm) between
scars in all but 1 patient, who had a single scar and only focal AT.
All 15 MacroATs were propagated through narrow channels. Ablation
within the channel eliminated all 15 MacroATs with 1 to 3 (median 1)
radiofrequency applications. Ablation was performed in 9 other channels
identified during MacroAT (5 patients) and in 5 channels identified
during atrial pacing (2 patients). Conduction block was obtained across
28 of 29 channels. After ablation, reproducible sustained right AT was
not induced in any patient. During follow-up (median 13.5 months), new
MacroATs, atrial fibrillation, or palpitations occurred in 3 of 16
patients.
Conclusions—MacroAT
after SR-CHD requires a large area of low voltage containing 
2 scars
forming narrow channels. Ablation within the channels eliminates
MacroAT.
Key Words: catheter ablation • heart defects, congenital • atrial flutter • Fontan procedure
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|
|
|
|
|
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