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European Heart Journal 2002 23(20):1609-1616; doi:10.1053/euhj.2002.3168
Copyright © 2002 by the European Society of Cardiology.
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Ablation of post-surgical intra-atrial reentrant tachycardia. Predilection target sites and mapping approach

W. Anné, H. van Rensburg, J. Adams, H. Ector, F. Van de Werf and H. Heidbüchelf1

Department of Cardiology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium

revised January 21, 2002; accepted January 23, 2002

Abstract

Background Atrial arrhythmias are a frequent complication of atrial surgery. The location of these tachycardias is very diverse due to the individual difference in the original anatomy, surgical corrections, and effects of atrial fibrosis. Nevertheless some recurrent patterns are emerging.

Methods and Results Forty-five patients underwent 51 ablation procedures between September 1995 and March 2001 using conventional mapping and temperature-controlled ablation. A duadecapolar catheter was swept from anterior to posterior in the right (and/or left) atrium, allowing for rapid mapping followed by entrainment confirmation. Twenty-eight patients had corrected congenital heart disease, 17 surgery for acquired heart disease. One hundred and sixteen arrhythmias were found, 86 circuits were targeted, 81 with success (94%). Despite the heterogeneous anatomy, the same targets were often encountered: the posterior isthmus between the inferior vena cava and the tricuspid ring (62%), the gap between the inferior vena cava and the atriotomy scar (49%), and the region around the atriopulmonary connection in Fontans (two out of four patients). After a mean follow-up of 24 months, 13 patients had a recurrent arrhythmia (29%) after their last procedure. There was a significant association between the number of circuits found during the initial procedure and the likelihood of recurrent arrhythmias.

Conclusions Knowledge of anatomical predilection sites and mapping the right (and/or left) atrium with a ‘sweeping Halo technique’ allow for effective ablation of most post-surgical atrial tachycardias. Severely damaged atria with multiple arrhythmias may require ‘preventive’ ablation of all recognizable channels.

Key Words: Intra-atrial reentrant tachycardia, surgery, radiofrequency ablation

f1 Correspondence: Hein Heidbüchel, MD, PhD, Cardiology, University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium.

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