Location of acutely successful radiofrequency catheter ablation of intraatrial reentrant tachycardia in patients with congenital heart disease
Abstract
Intraatrial reentrant tachycardia (IART) is common after surgery for congenital heart disease (CHD). Radiofrequency (RF) catheter ablation of IART targets anatomic areas critical to the maintenance of the arrhythmia circuit, areas that have not been well defined in this patient population. The purpose of this study was to determine the anatomic areas critical to IART circuits, defined by activation mapping and confirmed by an acutely successful RF ablation at the site. A total of 110 RF ablation procedures in 88 patients (median age 23.4 years, range 0.1 to 62.7) with CHD were reviewed. Patients were grouped according to surgical intervention: Mustard/Senning (n = 15), other biventricular repaired CHD (n = 24), Fontan (n = 43), and palliated CHD (n = 6). In first-time ablation procedures, > or = 1 IART circuits were acutely terminated in 80% of Mustard/Senning, 71% of repaired CHD, and 72% of Fontan (p = NS). The palliated CHD group underwent 1 of 6 successful procedures (17%), and this patient was excluded. The locations of acutely successful RF applications in Mustard/Senning patients (n = 14 sites) were at the tricuspid valve isthmus (57%) and at the lateral right atrial wall (43%). In patients with repaired CHD (n = 18 sites), successful RF sites were at the isthmus (67%) and the lateral (22%) and anterior (11%) right atria. In the Fontan group (n = 40 sites), successful RF sites included the lateral right atrial wall (53%), the anterior right atrium (25%), the isthmus area (15%), and the atrial septum (7%). Location of success was statistically different for the Fontan group (p = .002). In conclusion, the tricuspid valve isthmus is a critical area for ablation of IART during the Mustard/ Senning procedure and in patients with repaired CHD. IART circuits in Fontan patients are anatomically distinct, with the lateral right atrial wall being the more common area for successful RF applications. This information may guide RF and/or surgical ablation procedures in patients with CHD and IART.
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In patients with complex congenital heart disease who undergo Mustard, Senning, or Fontan procedures, complex suture lines and extensive myocardial damage create multiple substrates, while the cavotricuspid isthmus often remains a critical isthmus in the reentry circuit with difficult access for ablation.
“In patients with complex congenital heart disease undergoing the Mustard, Senning, or Fontan procedures, complex suture lines and large areas of myocardial damage create multiple substrates while in many cases the CTI is still a critical isthmus in the reentry circuit, with a difficult access for ablation.195,196”
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 [195]
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- Authors
- Collins, K. K., Love, B. A., Walsh, E. P., Saul, J. P., Epstein, M. R., & Triedman, J. K.
- Affiliations
- Boston Children's Hospital (US)
- Medical University of South Carolina (US)
- Cincinnati Children's Hospital Medical Center (US)
- Corresponding author
- Triedman, John K
- Venue
- The American Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2000-11
- Volume
- 86
- Issue
- 9
- Pages
- 969-974
- ISSN
- 0002-9149 (ISSN-L)
- OpenAlex
- W2025050000
- Cited by
- 194
- References
- 27
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 3 · 2023: 4 · 2022: 4 · 2021: 5 · 2020: 2 · 2019: 6 · 2018: 8 · 2017: 10 · 2016: 11 · 2015: 13 · 2014: 9 · 2013: 9 · 2012: 6
- FWCI
- 7.40
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Cardiology (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
- radiofrequency catheter ablation, congenital heart disease, Fontan circulation, interatrial septum, atrial activation mapping, atrial flutter, atrial tachycardia, atrial flutter ablation
- MeSH terms
- Adolescent, Adult, Child, Child, Preschool, Female, Heart Defects, Congenital, Cardiac Surgical Procedures, Humans, Infant, Infant, Newborn, Male, Middle Aged, Retrospective Studies, Sensitivity and Specificity, Tachycardia, Atrioventricular Nodal Reentry, Survival Analysis, Treatment Outcome, Catheter Ablation
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