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Erschienen in: Journal of Interventional Cardiac Electrophysiology 3/2020

09.08.2019

Lateral tunnel Fontan atrial tachycardia ablation trans-baffle access is not mandatory as the initial strategy

verfasst von: Abhishek Bhaskaran, Sachin Nayyar, Pradeepkumar Charla, Yawer Saeed, Shouvik Haldar, Andreu Porta-Sánchez, Priyanka Kugamoorthy, Amanvir Hans, Christian Jons, Erwin Oechslin, Edward Hickey, Louise Harris, Candice Silversides, S. Lucy Roche, Eugene Downar, Kumaraswamy Nanthakumar, Krishnakumar Nair

Erschienen in: Journal of Interventional Cardiac Electrophysiology | Ausgabe 3/2020

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Abstract

Background

Mapping and ablation of atrial tachycardia (AT) is commonly performed in lateral tunnel Fontan (LTF) patients, yet there is little information on the need of baffle puncture to access the pulmonary venous atrium (PVA). This study aimed to evaluate the most common chamber location of critical sites for majority of AT in LTF patients.

Methods

Consecutive LTF patients underwent catheter-based high-density mapping and ablation of AT from Nov. 2015 to Mar. 2019. Critical sites were identified by a combination of activation and entrainment mapping. Acute procedural success was defined as AT termination with ablation and non-inducibility of any AT. Predictors for ablation failure were evaluated in retrospect.

Results

Fifteen catheter ablation procedures were performed in 9 patients. A total of 15 clinical ATs (mean TCL 369 ± 91 ms) were mapped. The mechanism was macro re-entry in 11 (73%) and micro re-entry in 2. In 11 ATs (73%), 94 ± 5% of tachycardia cycle length (TCL) were mapped inside the tunnel. The commonest site of successful ablation in the tunnel was on the lateral wall (60%). Trans-baffle access was obtained during 5 of 15 procedures (33%). Overall, procedural success was achieved in 9 of 15 procedures (60%). There were no complications. Recurrence of AT was 42% over a follow-up period of 4.3 ± 3.2 years. Faster TCL of 200–300 ms showed a trend towards ablation failure, (OR 17, 95% CI 0.7 to 423, p = 0.08).

Conclusions

Catheter ablation can be performed effectively for ATs in LTF patients usually from inside the tunnel. ATs with critical sites in the PVA are uncommon. This information will help plan ablation in LTF patients without resorting to initial trans-baffle access.
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Metadaten
Titel
Lateral tunnel Fontan atrial tachycardia ablation trans-baffle access is not mandatory as the initial strategy
verfasst von
Abhishek Bhaskaran
Sachin Nayyar
Pradeepkumar Charla
Yawer Saeed
Shouvik Haldar
Andreu Porta-Sánchez
Priyanka Kugamoorthy
Amanvir Hans
Christian Jons
Erwin Oechslin
Edward Hickey
Louise Harris
Candice Silversides
S. Lucy Roche
Eugene Downar
Kumaraswamy Nanthakumar
Krishnakumar Nair
Publikationsdatum
09.08.2019
Verlag
Springer US
Erschienen in
Journal of Interventional Cardiac Electrophysiology / Ausgabe 3/2020
Print ISSN: 1383-875X
Elektronische ISSN: 1572-8595
DOI
https://doi.org/10.1007/s10840-019-00580-5

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