Atrial flutter catheter ablation in adult patients with repaired tetralogy of Fallot: mechanisms and outcomes of percutaneous catheter ablation in a consecutive series
Abstract
Background Prior investigators note successful ablation of both typical cavotricuspid isthmus-dependent and scar-related macroreentrant right atrial flutters (AFL) in adult patients with repaired tetralogy of Fallot (TOF). However, an analysis of the mechanisms (including a description of a uniform approach to diagnose such mechanisms), and clinical outcomes of catheter ablation in a consecutive series of adult patients with AFL late after surgical TOF repair has not been previously reported.Methods Background clinical data and follow-up were evaluated in a consecutive series of TOF patients evaluated from September 2001 to June 2008.Results We report a prevalence of sustained, symptomatic AFL in patients with repaired TOF equal to 20% (28/140 patients), and of recurrent, drug-refractory and/or severely symptomatic AFL to be 11% (16/140 patients). The AFLs manifested variable cycle lengths ranging from 215 to 525 ms. Underlying mechanisms were: (1) cavotricuspid (CTI)-dependent, counterclockwise atrial flutter (n=8 patients); (2) non-CTI-dependent macroreentrant scar-related AFL (n=6 patients); and (3) both CTI- and non-CTI-dependent macroreentrant AFL (n=2 patients). Recurrent arrhythmias occurred in six patients, five of whom were successfully treated with repeat ablation. After a mean follow-up of 23 months, 15 of 16 patients were alive and free of sustained AFL.Conclusions AFL late after surgical TOF repair occurs in 20% of such patients. In more than half of these patients, the AFLs are drug-refractory and/or severely symptomatic. Despite the presence of congenital heart disease treated with prior cardiac surgery and AFLs with variable atrial cycle lengths, the CTI-dependent mechanism underlies approximately half of the sustained, symptomatic AFLs.
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Atrial flutters are drug-refractory and/or severely symptomatic in more than half of patients, and the CTI-dependent mechanism underlies approximately half of sustained, symptomatic AFLs.
“The atrial flutters are drug-refractory and/or severely symptomatic in more than half of the patients, and the CTI-dependent mechanism underlies approximately half of the sustained, symptomatic AFLs.388”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [388]
Incisional related AFL is common (20%) as is sustained VT (11%) and risk of SCD (8%).
“Incisional related AFL is common (20%) as is sustained VT (11%) and risk of SCD (8%).387,388”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [388]
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- Authors
- Biviano, A., Garan, H., Hickey, K., Whang, W., Dizon, J., & Rosenbaum, M.
- Affiliations
- Columbia University Irving Medical Center (US)
- Columbia University (US)
- Corresponding author
- Biviano, Angelo
- Venue
- Journal of Interventional Cardiac Electrophysiology
- Published
- 2010-04-14
- Volume
- 28
- Issue
- 2
- Pages
- 125-135
- ISSN
- 1383-875X (ISSN-L)
- 1572-8595
- OpenAlex
- W2023036617
- Cited by
- 25
- References
- 31
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 1 · 2022: 1 · 2019: 2 · 2018: 1 · 2017: 3 · 2016: 4 · 2015: 1 · 2014: 2 · 2013: 1 · 2012: 1
- FWCI
- 1.10
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of Interventional Cardiac Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Keywords
- atrial flutter, repaired tetralogy of Fallot, catheter ablation, adult congenital heart disease, recurrent arrhythmia, drug-refractory arrhythmia, atrial cycle length, ablation outcomes
- MeSH terms
- Adult, Atrial Flutter, Female, Humans, Male, Middle Aged, Recurrence, Retrospective Studies, Tetralogy of Fallot, Prevalence, Treatment Outcome, Catheter Ablation, Electrophysiologic Techniques, Cardiac
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