Heart rhythm · 2026
Arrhythmias in d-transposition of the great arteries after Mustard- or Senning-type atrial redirection surgery: 22 years of experience in catheter ablation and follow-up.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
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Neumann Stephan, Vöth Sandra, Jerosch-Herold Michael, Veltmann Christian, Hebe Joachim
Аннотация
BACKGROUND: Until the late 1980s, dextro-transposition of the great arteries (d-TGA) was primarily treated with Mustard or Senning (M/S) atrial redirection surgery. Common long-term complications in these patients include atrial tachyarrhythmias, yet data on catheter ablation in this population remain limited.
OBJECTIVE: This study aimed to assess procedural characteristics, acute success, and long-term outcomes.
METHODS: We retrospectively analyzed all patients with d-TGA after M/S surgery who underwent electrophysiologic procedures for atrial tachyarrhythmia at a tertiary referral center between June 2001 and June 2023.
RESULTS: 97 patients (35% female; 50 Mustard) underwent 160 electrophysiological procedures. A total of 111 tachyarrhythmias were identified. Cavotricuspid isthmus (CTI)-dependent macro-reentrant atrial tachycardia was the most common substrate and was successfully treated in 90% of procedures. Localized reentrant atrial tachycardia was the second most frequent arrhythmia with an age-dependent increase in relative frequency. Overall, 86% of substrate-guided ablations were acutely successful. In procedures with non-inducible or non-sustained arrhythmias, strategic CTI ablation was performed routinely. During a median follow-up of 6.0 years, 95 tachyarrhythmias occurred, of which 13% represented recurrences of previously ablated arrhythmias. Strategic CTI ablation was not associated with a statistically significant increase in subsequent arrhythmias compared with substrate-guided ablations. Arrhythmias during follow-up were more common after Mustard than Senning surgery (hazard ratio, 1.87; 95% confidence interval, 1.06-3.31; P = .030).
CONCLUSION: Catheter ablation in patients with d-TGA with M/S surgery is feasible and highly effective, with durable results for targeted arrhythmias. However, the high incidence of de novo arrhythmias underscores the persistent risk for arrhythmias in this population and highlights the need for adjusted long-term management strategies.
OBJECTIVE: This study aimed to assess procedural characteristics, acute success, and long-term outcomes.
METHODS: We retrospectively analyzed all patients with d-TGA after M/S surgery who underwent electrophysiologic procedures for atrial tachyarrhythmia at a tertiary referral center between June 2001 and June 2023.
RESULTS: 97 patients (35% female; 50 Mustard) underwent 160 electrophysiological procedures. A total of 111 tachyarrhythmias were identified. Cavotricuspid isthmus (CTI)-dependent macro-reentrant atrial tachycardia was the most common substrate and was successfully treated in 90% of procedures. Localized reentrant atrial tachycardia was the second most frequent arrhythmia with an age-dependent increase in relative frequency. Overall, 86% of substrate-guided ablations were acutely successful. In procedures with non-inducible or non-sustained arrhythmias, strategic CTI ablation was performed routinely. During a median follow-up of 6.0 years, 95 tachyarrhythmias occurred, of which 13% represented recurrences of previously ablated arrhythmias. Strategic CTI ablation was not associated with a statistically significant increase in subsequent arrhythmias compared with substrate-guided ablations. Arrhythmias during follow-up were more common after Mustard than Senning surgery (hazard ratio, 1.87; 95% confidence interval, 1.06-3.31; P = .030).
CONCLUSION: Catheter ablation in patients with d-TGA with M/S surgery is feasible and highly effective, with durable results for targeted arrhythmias. However, the high incidence of de novo arrhythmias underscores the persistent risk for arrhythmias in this population and highlights the need for adjusted long-term management strategies.