Delineation of intra-atrial reentrant tachycardia circuits after mustard operation for transposition of the great arteries using biatrial electroanatomic mapping and entrainment mapping
Abstract
INTRODUCTION: Intra-atrial reentrant tachycardia (IART) circuits after Mustard operation remain incompletely understood due to the complex atrial anatomy after extensive surgical procedures. The aim of this study was to delineate IART circuits and their relations to the individual anatomic boundaries in Mustard patients. METHODS AND RESULTS: Twelve patients (10 men and 2 women; age 29 +/- 4.6 years) with atrial tachyarrhythmias after Mustard operation were included in this study. During 14 IARTs and 2 focal atrial tachycardias, electroanatomic mapping and entrainment mapping were performed in both the systemic venous atrium and the pulmonary venous atrium. The latter was accessed via a retrograde transaortic approach. Thirteen IARTs used a single-loop reentrant circuit, and 1 IART used a dual-loop reentrant circuit. Ten (77%) of 13 single-loop reentrant circuits used the tricuspid annulus (TA) as their central barrier. The remaining 3 IARTs rotated around the inferior vena cava (IVC) (n = 2) or ostium of the right upper pulmonary vein (n = 1). In 6 (60%) of the 10 peritricuspid IARTs, both pulmonary venous atrium and systemic venous atrium components of the mid-portion of the TA-IVC isthmus were demonstrated to be part of the reentry. Overall, 12 (86%) of 14 IARTs in 10 patients were successfully ablated by bridging two barriers that constrained the reentrant circuit. Eight (80%) of 10 peritricuspid circuits were abolished by linear ablation connecting the TA to the IVC (n = 4), incisional scar (n = 2), patch (n = 1), and atriotomy (n = 1). CONCLUSIONS: In Mustard patients, the TA serves as the most frequent central barrier of IART. Biatrial electroanatomic mapping combined with entrainment mapping facilitates delineation of IART circuits in relation to their anatomic barriers and enables the design of individual ablation strategies to achieve high success.
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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 [196]
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- Authors
- ZRENNER, B., DONG, J., SCHREIECK, J., NDREPEPA, G., MEISNER, H., KAEMMERER, H., SCHÖMIG, A., HESS, J., & SCHMITT, C.
- Affiliations
- TUM Klinikum (DE)
- Corresponding author
- ZRENNER, BERNHARD
- Venue
- Journal of Cardiovascular Electrophysiology
- Publisher
- Wiley
- Published
- 2003-12
- Volume
- 14
- Issue
- 12
- Pages
- 1302-1310
- ISSN
- 1045-3873 (ISSN-L)
- 1540-8167
- OpenAlex
- W2059515316
- Cited by
- 64
- References
- 27
- Citations by year
- 2025: 3 · 2024: 1 · 2023: 2 · 2022: 4 · 2021: 1 · 2020: 2 · 2019: 1 · 2017: 9 · 2016: 4 · 2015: 3 · 2014: 1 · 2013: 4 · 2012: 2
- FWCI
- 1.98
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Cardiovascular Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion)
- 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 › Cardiac electrophysiology and arrhythmias
- Keywords
- intra-atrial reentrant tachycardia, Mustard operation, transposition of the great arteries, atrial tachyarrhythmia, electroanatomical mapping, entrainment mapping, tricuspid annulus, inferior vena cava, catheter ablation
- MeSH terms
- Adult, Electrophysiology, Female, Heart Atria, Cardiac Surgical Procedures, Humans, Male, Prospective Studies, Tachycardia, Ectopic Atrial, Transposition of Great Vessels, Vena Cava, Inferior, Catheter Ablation, Body Surface Potential Mapping
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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