Transbaffle mapping and ablation for atrial tachycardias after mustard, senning, or Fontan operations
Open accessAbstract
BACKGROUND: In Fontan and atrial switch patients, transcatheter ablation is limited by difficult access to the pulmonary venous atrium. In recent years, transbaffle access (TBA) has been described, but limited data document its safety and utility. METHODS AND RESULTS: All ablative electrophysiological study cases of this population performed between January 2006 and December 2010 at Boston Children's Hospital were reviewed. Pre-case and follow-up clinical characteristics were documented. Adverse events were classified by severity and attributability to the intervention. We included 118 cases performed in 90 patients. TBA was attempted in 74 cases and was successful in 96%: in 20 via baffle leak or fenestration and in 51 (94%) of 54 using standard or radiofrequency transseptal techniques. There were 10 procedures with adverse events ranked as moderate or more severe. The event rate was similar in both groups (TBA 8% versus non-TBA 9%, P = 1), and no events were directly attributable to TBA. There was a trend to higher proportion of cases having a > 5-point drop in saturations from baseline in the TBA group versus the non-TBA group in Fontan cases (15% vs 0%, P = 0.14). When cases with follow-up > 90 and > 365 days were analyzed, the median initial arrhythmia score of 5 significantly changed--3 points in both time periods (P ≤ 0.001). CONCLUSIONS: TBA is feasible in this population; its use was not associated with a higher incidence of adverse events; and changes in clinical scores support its efficacy. Desaturation observed in some patients is of uncertain significance but warrants postablation monitoring and prospective study.
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In recent years, trans-baffle access has been described, and was successful in 96% of 74 attempted cases and does not seem to be associated with a higher incidence of adverse events.
“In recent years, trans-baffle access has been described, and was successful in 96% of 74 attempted cases and does not seem to be associated with a higher incidence of adverse events.361”
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 [361]
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Cites
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MethodCardiac Rhythm after the Mustard Operation for Complete Transposition of the Great Arteries
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“Since that report, only case reports or very small series have published results of this technique in EPS with Fontan and atrial switch patients.(11,17,18)”
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- Authors
- Correa, R., Walsh, E. P., Alexander, M. E., Mah, D. Y., Cecchin, F., Abrams, D. J., & Triedman, J. K.
- Affiliations
- Boston Children's Hospital (US)
- Corresponding author
- Correa, Rafael
- ORCID
- Venue
- Journal of the American Heart Association
- Published
- 2013-09-26
- Volume
- 2
- Issue
- 5
- Pages
- e000325-e000325
- ISSN
- 2047-9980 (ISSN-L)
- PMC
- PMC3835240
- OpenAlex
- W2131619407
- Cited by
- 57
- References
- 19
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 2 · 2023: 4 · 2022: 1 · 2021: 4 · 2020: 2 · 2019: 7 · 2018: 6 · 2017: 8 · 2016: 7 · 2015: 7 · 2014: 2
- FWCI
- 3.63
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- Journal of the American Heart Association (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- 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, Fontan circulation, atrial switch operation, Mustard operation, Senning procedure, Fontan procedure, catheter ablation, radiofrequency ablation, baffle leak, procedural adverse events, desaturation, congenital heart disease
- MeSH terms
- Adolescent, Adult, Child, Child, Preschool, Heart Atria, Cardiac Surgical Procedures, Humans, Infant, Middle Aged, Prospective Studies, Retrospective Studies, Tachycardia, Catheter Ablation, Fontan Procedure, Young Adult
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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