Heart rhythm · 2025
A novel approach to treat atrial tachycardia by catheter ablation in patients after orthotopic biatrial heart transplantation: The L-line.
СтатьяНазвание и аннотация: Перевод в очереди
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Khalaph Moneeb, Trajkovska Nadica, Sohns Christian, Guckel Denise, Didenko Maxim, Braun Martin, Imnadze Guram, Lucas Philipp, Fink Thomas, Sciacca Vanessa, Beyer Sebastian, Nageler Gregor, Fleischhauer Jan, Schramm René, Costard-Jäckle Angelika, Fox Henrik, Gummert Jan, Sommer Philipp, El Hamriti Mustapha
Аннотация
BACKGROUND: Atrial tachycardia (AT) is commonly observed after orthotopic biatrial heart transplantation (O-BA-HTx). Its clinical presentation, relationship to atrial anastomoses, and electrophysiologic characteristics remain controversial. Novel radiofrequency-guided catheter ablation (RFCA) strategies using electroanatomical mapping and myocardial substrate characterization have emerged, but data on their efficacy in this patient group are scarce.
OBJECTIVE: This study aimed to evaluate the efficacy and safety of a novel RFCA strategy for AT in O-BA-HTx patients and assess long-term arrhythmia-free survival.
METHODS: Overall, 37 consecutive O-BA-HTx patients with therapy-refractory AT underwent prospectively an RFCA between 2017 and 2024. Procedural parameters, acute and long-term outcomes, and complications were assessed.
RESULTS: The cohort (mean age 56.9 ± 16.3 years, 83.8% male) underwent RFCA of AT. Electrophysiologic diagnoses included: The L-line approach, which combines cavotricuspid isthmus and RA-lateral line ablation, was responsible for AT termination in 92.1% (n = 34) of cases. All procedures were performed without any major complications. The median follow-up was 26 months (interquartile range 19-60), and only 2 patients (5.3%) experienced AT recurrence. Remarkably, achieving freedom from AT was associated with freedom from atrial fibrillation, highlighting the effectiveness of addressing AT as a trigger for atrial fibrillation.
CONCLUSION: The novel L-Line approach is a safe, effective, and reproducible approach for AT ablation in O-BA-HTx patients, with favorable long-term arrhythmia-free survival.
OBJECTIVE: This study aimed to evaluate the efficacy and safety of a novel RFCA strategy for AT in O-BA-HTx patients and assess long-term arrhythmia-free survival.
METHODS: Overall, 37 consecutive O-BA-HTx patients with therapy-refractory AT underwent prospectively an RFCA between 2017 and 2024. Procedural parameters, acute and long-term outcomes, and complications were assessed.
RESULTS: The cohort (mean age 56.9 ± 16.3 years, 83.8% male) underwent RFCA of AT. Electrophysiologic diagnoses included: The L-line approach, which combines cavotricuspid isthmus and RA-lateral line ablation, was responsible for AT termination in 92.1% (n = 34) of cases. All procedures were performed without any major complications. The median follow-up was 26 months (interquartile range 19-60), and only 2 patients (5.3%) experienced AT recurrence. Remarkably, achieving freedom from AT was associated with freedom from atrial fibrillation, highlighting the effectiveness of addressing AT as a trigger for atrial fibrillation.
CONCLUSION: The novel L-Line approach is a safe, effective, and reproducible approach for AT ablation in O-BA-HTx patients, with favorable long-term arrhythmia-free survival.