Ablation of atrial tachycardia after surgery for congenital and acquired heart disease using an electroanatomic mapping system: which circuits to expect in which substrate?
Abstract
Objectives The purpose of this study was to compare atrial tachycardia circuits after a range of cardiac operations.Background Knowledge of circuits occurring in a given postsurgical substrate should help to ablate these challenging tachycardias and develop potential preventive strategies.Methods We analyzed tachycardia circuits in 83 consecutive patients (60 males; median age 47 years, range 9-73) after atrial incisions undergoing ablation of atrial tachycardias. A combined strategy of electroanatomic (CARTO) and entrainment mapping was used. Fifty-two patients (63%) underwent operation for congenital and 31 (37%) for acquired heart disease. Patients were divided into subgroups based on the intervention performed in the atria: right lateral atriotomy (39 patients), left atrial (11) and superior transseptal (10) approach to the mitral valve, biatrial heart transplantation (8), Mustard (8) and Fontan (4) procedure, and other interventions (3).Results Most of the 119 tachycardias mapped were isthmus-dependent atrial flutter (66) and incisional tachycardia (30). Isthmus-dependent atrial flutter was the most frequent arrhythmia in all subgroups except for Fontan patients, in whom incisional tachycardia was most frequent. The distribution of tachycardia circuits did not differ significantly among groups.Conclusions The observed circuits did not differ among the postsurgical substrates. Isthmus-dependent atrial flutter should be the first circuit considered in patients after atrial incisions.
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Multiple circuits are possible in AFL, including CTI-dependent AFL which remains the most common type even after surgery or ablation.
“Multiple circuits are possible, including CTI-dependent AFL which still is the most common type even in these situations.11,159,160”
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 [159]
In scar-related areas of block, the ECG pattern may not be typical, and conversely a typical AFL ECG may be produced by atypical MRT even due to LA circuits.
“In these cases with scar-related areas of block the ECG pattern may not Table 12 Therapy of atrial flutter/ macro-reentrant tachycardia Recommendation Reference Acute therapy Synchronised DC cardioversion is recommended for haemodynamically unstable patients with AFL/MRT a 131,132 IV anticoagulation may be considered in case emergency cardioversion is necessary.Anticoagulation should be continued”
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 [159]
These non-excitable areas may form mixed obstacles by attaching to anatomical obstacles such as the mitral valve or pulmonary veins.
“These non-excitable areas may form mixed obstacles by attaching to anatomical obstacles, such as the mitral valve or the pulmonary veins.118,159,162,191,192”
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 [159]
Atypical atrial flutter/macroreentrant tachycardia of the left atrium is generally supported by abnormal, non-excitable areas of myocardium, sometimes from surgical or ablation scars and sometimes of unknown origin.
“Atypical AFL/MRT of the LA is generally supported by abnormal, non-excitable areas of myocardium, sometimes due to surgical or ablation scars and others of unknown origin.”
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 [159]
Macroreentrant tachycardia circuits may rotate around the superior vena cava and upper crista terminalis ('upper loop') or around a lateral right atrial surgical scar or a septal patch.
“MRT circuits may turn around the SVC and the upper portions of the crista terminalis ('upper loop') or around a lateral RA surgical scar or a septal patch.159,194”
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 [159]
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- Authors
- Lukac, P., Pedersen, A. K., Mortensen, P. T., Jensen, H. K., Hjortdal, V., & Hansen, P. S.
- Affiliations
- Aarhus University Hospital (DK)
- Venue
- Heart Rhythm
- Publisher
- Elsevier BV
- Published
- 2005-01
- Volume
- 2
- Issue
- 1
- Pages
- 64-72
- ISSN
- 1547-5271 (ISSN-L)
- OpenAlex
- W2028767597
- Cited by
- 123
- References
- 24
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 5 · 2023: 7 · 2022: 6 · 2021: 5 · 2020: 3 · 2019: 3 · 2018: 10 · 2017: 11 · 2016: 9 · 2015: 13 · 2014: 10 · 2013: 7 · 2012: 5
- FWCI
- 3.18
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Heart Rhythm (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 tachycardia, electroanatomical mapping, isthmus-dependent atrial flutter, congenital heart disease, acquired heart disease, Fontan procedure, Mustard procedure, heart transplantation, entrainment mapping, ablation strategy
- MeSH terms
- Atrial Flutter, Female, Follow-Up Studies, Heart Defects, Congenital, Heart Diseases, Humans, Male, Middle Aged, Postoperative Complications, Retrospective Studies, Tachycardia, Tachycardia, Atrioventricular Nodal Reentry, Catheter Ablation, Electrophysiologic Techniques, Cardiac
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