Ultra-High-Density Activation Mapping to Aid Isthmus Identification of Atrial Tachycardias in Congenital Heart Disease.
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Martin Claire A, Yue Arthur, Martin Ruairidh, Claridge Simon, Sawhney Vinit, Maury Philippe, Lowe Martin, Combes Nicolas, Heck Patrick, Begley David, Fynn Simon, Snowdon Richard, Seller Neil, Murray Stephen, Shepherd Ewen, Ezzat Vivienne, Gajendragadkar Parag R, Honarbakhsh Shohreh, Takigawa Masateru, Cheniti Ghassen, Frontera Antonio, Thompson Nathaniel, Massouillie Gregoire, Kitamura Takeshi, Wolf Michael, Duchateau Josselin, Klotz Nicholas, Vlachos Konstantinos, Bourier Felix, Lam Anna, Pambrun Thomas, Denis Arnaud, Sacher Frederic, Cochet Hubert, Jais Pierre, Hocini Meleze, Haissaguerre Michel, Iriart Xavier, Thambo Jean-Benoît, Derval Nicolas
Аннотация
BACKGROUND: The incidence of atrial arrhythmias post-surgery for CHD is high. Catheter ablation has emerged as an effective treatment, but is hampered by limitations in the mapping system's ability to accurately define the tachycardia circuit.
METHODS: Mapping and ablation data of 61 patients with CHD (35 males, age 45 ± 14 years) from 8 tertiary centers were reviewed.
RESULTS: Causes were as follows: Transposition of Great Arteries (atrial switch) (n = 7); univentricular physiology (Fontans) (n = 8); Tetralogy of Fallot (n = 10); atrial septal defect (ASD) repair (n = 15); tricuspid valve (TV) anomalies (n = 10); and other (n = 11). The total number of atrial arrhythmias was 86. Circuits were predominantly around the tricuspid valve (n = 37), atriotomy scar (n = 10), or ASD patch (n = 4). Although the majority of peri-tricuspid circuits were cavo-tricuspid-isthmus dependent (n = 30), they could follow a complex route between the annulus and septal resection, ASD patch, coronary sinus, or atriotomy. Immediate ablation success was achieved in all but 2 cases; with follow-up of 12 ± 8 months, 7 patients had recurrence.
CONCLUSIONS: We demonstrate the feasibility of the basket catheter for mapping complex CHD arrhythmias, including with transbaffle and transhepatic access. Although the circuits often involve predictable anatomic landmarks, the precise critical isthmus is often difficult to predict empirically. Ultra-high-density mapping enables elucidation of circuits in this complex anatomy and allows successful treatment at the isthmus with a minimal lesion set.