+ Most Popular
Cunninghamia lanceolata plantations in China
Mammalian lairs in paleo ecological studies and palynology
Studies on technological possibilities in utilization of anhydrous milk fat for production of recombined butter-like products
Should right-sided fibroelastomas be operated upon?
Large esophageal lipoma
Apoptosis in the mammalian thymus during normal histogenesis and under various in vitro and in vivo experimental conditions
Poissons characoides nouveaux ou non signales de l'Ilha do Bananal, Bresil
Desensitizing efficacy of Colgate Sensitive Maximum Strength and Fresh Mint Sensodyne dentifrices
Administration of fluid by subcutaneous infusion: revival of a forgotten method
Tundra mosquito control - an impossible dream?
Schizophrenia for primary care providers: how to contribute to the care of a vulnerable patient population
Geochemical pattern analysis; method of describing the Southeastern limestone regional aquifer system
Incidence of low birth weights in a hospital of Mexico City
Graded management intensity of grassland systems for enhancing floristic diversity
Microbiology and biochemistry of cheese and fermented milk
The ember tetra: a new pygmy characid tetra from the Rio das Mortes, Brazil, Hyphessobrycon amandae sp. n. (Pisces, Characoidei)
Risk factors of contrast-induced nephropathy in patients after coronary artery intervention
Renovation of onsite domestic wastewater in a poorly drained soil
Observations of the propagation velocity and formation mechanism of burst fractures caused by gunshot
Systolic blood pressure in a population of infants in the first year of life: the Brompton study
Haematological studies in rats fed with metanil yellow
Studies on pasteurellosis. I. A new species of Pasteurella encountered in chronic fowl cholera
Dormancy breaking and germination of Acacia salicina Lindl. seeds
therapy of lupus nephritis. a two-year prospective study

Atrial tachycardia ablation in patients with a functional single ventricle after the Fontan surgery

Atrial tachycardia ablation in patients with a functional single ventricle after the Fontan surgery

Kardiologia Polska 74(8): 762-771

ISSN/ISBN: 0022-9032

PMID: 26575308

Atrial tachyarrhythmias are a leading source of morbidity and mortality after Fontan-type procedures and antiarrhythmic drug therapy is often ineffective in these patients. To evaluate short- and long-term outcomes of radiofrequency current ablation for atrial tachycardia (AT) in patients after the Fontan procedure, and to report clinical, electrophysiological and electroanatomical characteristics of these arrhythmias. We retrospectively analysed data obtained in 8 patients (5 males, 3 females) after the Fontan procedure who underwent ablation for AT between 2002 and 2013. In order to compare the clinical impact of arrhythmia before and after ablation, we used the modified arrhythmia score, ranging from 0 (no arrhythmia activity) to 12 (very severe arrhythmia). In all patients, electroanatomical mapping using the CARTO system was performed, allowing semiquantification of low-voltage (< 0.5 mV) areas and scars. Seven patients had an atriopulmonary connection and 1 patient had an extracardiac conduit. The mean patient age was 9.4 ± 3.1 years at the time of the Fontan procedure and 26.2 ± 4.6 years at the time of the first ablation. A total of 18 ablations were performed with no complications, 1 to 4 (median 2.5) procedures per patient. In patients who had more than 1 ablation, the mean time from the first to the last procedure was 34.8 months (range 1-64 months). In individual patients, 1 to 4 (median 2.5) different ATs were observed, with the mean tachycardia cycle length of 334 ± 95 ms. In 6 patients, low-voltage area (< 0.5 mV) comprised 25-50% of the right atrium, and in two others it comprised 10-25% and < 10% of the right atrium, respectively. Seven procedures were fully successful (ablation of all ATs), 7 were partially successful (ablation of only some AT, including clinical arrhythmia, but not of all ATs) and 4 were unsuccessful (failed ablation of clinical AT). The mean procedural, fluoroscopy and ablation times were 176 ± 54.6, 13.7 ± 5.7 and 21.7 ± 11.9 min, respectively. Freedom from arrhythmia during the mean follow-up of 58.6 ± 46 months (range 11-127 months) since the last procedure was obtained in 4 patients. The median arrhythmia score after the last ablation was significantly reduced compared to baseline (4.5 vs. 8; p < 0.05). Catheter ablation of AT in patients after the Fontan procedure is safe but its acute and long-term efficacy is limited. Due to complex and extensive substrate, along with complex anatomy, recurrences are frequent and patients may require repeat ablation procedures. Suppression of arrhythmia is associated with an improved clinical status of the patients.

Please choose payment method:

(PDF emailed within 1 workday: $29.90)

Accession: 057264017

Download citation: RISBibTeXText

Related references

Electrophysiologic characterisation and radiofrequency ablation of atrial tachycardia in patients after Fontan surgery using a non-contact mapping system. European Heart Journal 20(ABSTR Suppl ): 139, 1999

Mechanisms, treatment, and prevention of atrial reentry tachycardia after surgery for congenital heart disease: Intracardiac mapping and ablation in Fontan patients. Progress in Pediatric Cardiology 14(3): 217-221, 2002

Successful Ablation of Atrial Tachycardia Originating from Inside the Single Atrium and Conduit After a Fontan Operation. International Heart Journal 61(1): 174-177, 2020

Influence of myocardial mass of the univentricular heart on exercise capacity in patients with functional single ventricle and Fontan surgery. Zeitschrift für Kardiologie 93(3): 222-228, 2004

Pseudoaneurysm Development After Ablation for Atrial Tachycardia in a Patient With Single-Ventricle Anatomy. Jacc. Clinical Electrophysiology 2(4): 524-525, 2016

Atrial tachycardia ablation in a patient with double outlet right ventricle corrected by surgery. Revista Portuguesa de Cardiologia: Orgao Oficial da Sociedade Portuguesa de Cardiologia 23(2): 163-177, 2004

Electrophysiological mapping and ablation of intra-atrial reentry tachycardia after Fontan surgery with the use of a noncontact mapping system. Circulation 102(4): 419-425, 2000

Transthoracic percutaneous access for electroanatomic mapping and catheter ablation of atrial tachycardia in patients with a lateral tunnel Fontan. Heart Rhythm 3(1): 37-43, 2006

Macroreentrant atrial tachycardia in patients without previous atrial surgery or catheter ablation: clinical and electrophysiological characteristics of scar-related left atrial anterior wall reentry. Journal of Cardiovascular Electrophysiology 24(4): 404-412, 2013

Fontan Completion for Younger than 3 Years of Age: Outcome in Patients with Functional Single Ventricle. Pediatric cardiology 36(8): 1680-1684, 2015

Scar-related right atrial macroreentrant tachycardia in patients without prior atrial surgery: electroanatomic characterization and ablation outcome. Heart Rhythm 2(6): 594-601, 2005

Risk factors for cerebrovascular events following fontan palliation in patients with a functional single ventricle. American Journal of Cardiology 96(4): 587-591, 2005

Impact of early Fontan completion on postoperative outcomes in patients with a functional single ventricle. European Journal of Cardio-Thoracic Surgery: Official Journal of the European Association for Cardio-Thoracic Surgery 51(5): 995-1002, 2017

Radiofrequency ablation for intra-atrial reentrant tachycardia after surgical palliation for single ventricle Entrainment techniques to define a critical isthmus in the reentrant circuit. Circulation 94(8): I176, 1996

Transconduit puncture for catheter ablation of atrial tachycardia in a patient with extracardiac Fontan palliation. Heart Rhythm 7(3): 413-416, 2010