open access

Vol 64, No 12 (2006)
Other
Published online: 2006-12-21
Submitted: 2012-12-28
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Original article
Radio-frequency ablation of arrhythmias following congenital heart surgery

Zbigniew Kalarus, Oskar Kowalski, Radosław Lenarczyk, Patrycja Pruszkowska-Skrzep, Sławomir Pluta, Bożena Zeifert, Beata Chodór, Jacek Białkowski, Janusz Skalski, Marian Zembala
Kardiol Pol 2006;64(12):1343-1348.

open access

Vol 64, No 12 (2006)
Other
Published online: 2006-12-21
Submitted: 2012-12-28

Abstract

Abstract Background: Cardiac arrhythmias as a late complication following congenital heart surgery are encountered more and more frequently in clinical practice. The use of new electrophysiological methods of visualisation and mapping improves the efficacy of radio-frequency (RF) ablation of these arrhythmias. Aim: To assess patterns of atrial arrhythmias following congenital heart surgery and to examine the efficacy of RF ablation using the electro-anatomical CARTO system. Methods: Electrophysiological diagnostic study and RF ablation were performed in 24 consecutive patients (mean age 36±18 years) who had atrial arrhythmias following congenital heart surgery. The mechanism of arrhythmia (ectopic or reentrant) and strategy of RF ablation procedure were based on the results of the right atrial map performed during index arrhythmia. Results: The patients were divided into five groups according to the type of congenital heart surgery. The ASD group consisted of 17 patients who had undergone in the past surgery due to atrial septal defect, four patients had a history of surgery due to ventricular septal defect (VSD group), and one patient each had undergone surgery due to corrected transposition of the great arteries (ccTGA), tetralogy of Fallot (TF) or dual-outflow right ventricle (DORV). During diagnostic electrophysiological study typical atrial flutter (AFL) was diagnosed in nine patients from the ASD group, atypical AFL in three ASD patients, and ectopic atrial tachycardia (EAT) in six ASD patients. In one patient EAT was induced after ablation of typical AFL. Of the VSD patients, three had atypical AFL, and one had typical AFL. The patient following surgery for ccTGA had atypical AFL and EAT, whereas in the two remaining patients (DORV and TF) atypical AFL was demonstrated. The efficacy of the first session of RF ablation was 83% and no complications were observed. The efficacy of RF ablation of typical AFL was 90%, atypical AFL 78%, and EAT 86% (NS). During the long-term follow-up (24±17 months) arrhythmia recurrences were noted in 2 (10%) out of 20 patients who were effectively treated during the first RF ablation session. Conclusions: Reentry is the most common electrophysiological mechanism of incisional tachycardias, followed by ectopic atrial tachycardia. RF ablation using the electro-anatomical CARTO system is effective and safe in this group of patients.

Abstract

Abstract Background: Cardiac arrhythmias as a late complication following congenital heart surgery are encountered more and more frequently in clinical practice. The use of new electrophysiological methods of visualisation and mapping improves the efficacy of radio-frequency (RF) ablation of these arrhythmias. Aim: To assess patterns of atrial arrhythmias following congenital heart surgery and to examine the efficacy of RF ablation using the electro-anatomical CARTO system. Methods: Electrophysiological diagnostic study and RF ablation were performed in 24 consecutive patients (mean age 36±18 years) who had atrial arrhythmias following congenital heart surgery. The mechanism of arrhythmia (ectopic or reentrant) and strategy of RF ablation procedure were based on the results of the right atrial map performed during index arrhythmia. Results: The patients were divided into five groups according to the type of congenital heart surgery. The ASD group consisted of 17 patients who had undergone in the past surgery due to atrial septal defect, four patients had a history of surgery due to ventricular septal defect (VSD group), and one patient each had undergone surgery due to corrected transposition of the great arteries (ccTGA), tetralogy of Fallot (TF) or dual-outflow right ventricle (DORV). During diagnostic electrophysiological study typical atrial flutter (AFL) was diagnosed in nine patients from the ASD group, atypical AFL in three ASD patients, and ectopic atrial tachycardia (EAT) in six ASD patients. In one patient EAT was induced after ablation of typical AFL. Of the VSD patients, three had atypical AFL, and one had typical AFL. The patient following surgery for ccTGA had atypical AFL and EAT, whereas in the two remaining patients (DORV and TF) atypical AFL was demonstrated. The efficacy of the first session of RF ablation was 83% and no complications were observed. The efficacy of RF ablation of typical AFL was 90%, atypical AFL 78%, and EAT 86% (NS). During the long-term follow-up (24±17 months) arrhythmia recurrences were noted in 2 (10%) out of 20 patients who were effectively treated during the first RF ablation session. Conclusions: Reentry is the most common electrophysiological mechanism of incisional tachycardias, followed by ectopic atrial tachycardia. RF ablation using the electro-anatomical CARTO system is effective and safe in this group of patients.
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Keywords

congenital heart surgery; inicisional tachycardias; RF ablation; electro-anatomical system; atrial flutter; ectopic atrial tachycardia

About this article
Title

Original article
Radio-frequency ablation of arrhythmias following congenital heart surgery

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 64, No 12 (2006)

Pages

1343-1348

Published online

2006-12-21

Bibliographic record

Kardiol Pol 2006;64(12):1343-1348.

Keywords

congenital heart surgery
inicisional tachycardias
RF ablation
electro-anatomical system
atrial flutter
ectopic atrial tachycardia

Authors

Zbigniew Kalarus
Oskar Kowalski
Radosław Lenarczyk
Patrycja Pruszkowska-Skrzep
Sławomir Pluta
Bożena Zeifert
Beata Chodór
Jacek Białkowski
Janusz Skalski
Marian Zembala

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