| Atrial flutter catheter ablation in adult patients with repaired tetralogy of Fallot: mechanisms and outcomes of percutaneous catheter ablation in a consecutive series. | |
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MedLine Citation:
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PMID: 20390332 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Prior investigators note successful ablation of both typical cavotricuspid isthmus-dependent and scar-related macroreentrant right atrial flutters (AFL) in adult patients with repaired tetralogy of Fallot (TOF). However, an analysis of the mechanisms (including a description of a uniform approach to diagnose such mechanisms), and clinical outcomes of catheter ablation in a consecutive series of adult patients with AFL late after surgical TOF repair has not been previously reported. METHODS: Background clinical data and follow-up were evaluated in a consecutive series of TOF patients evaluated from September 2001 to June 2008. RESULTS: We report a prevalence of sustained, symptomatic AFL in patients with repaired TOF equal to 20% (28/140 patients), and of recurrent, drug-refractory and/or severely symptomatic AFL to be 11% (16/140 patients). The AFLs manifested variable cycle lengths ranging from 215 to 525 ms. Underlying mechanisms were: (1) cavotricuspid (CTI)-dependent, counterclockwise atrial flutter (n=8 patients); (2) non-CTI-dependent macroreentrant scar-related AFL (n=6 patients); and (3) both CTI- and non-CTI-dependent macroreentrant AFL (n=2 patients). Recurrent arrhythmias occurred in six patients, five of whom were successfully treated with repeat ablation. After a mean follow-up of 23 months, 15 of 16 patients were alive and free of sustained AFL. CONCLUSIONS: AFL late after surgical TOF repair occurs in 20% of such patients. In more than half of these patients, the AFLs are drug-refractory and/or severely symptomatic. Despite the presence of congenital heart disease treated with prior cardiac surgery and AFLs with variable atrial cycle lengths, the CTI-dependent mechanism underlies approximately half of the sustained, symptomatic AFLs. |
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Authors:
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Angelo Biviano; Hasan Garan; Kathleen Hickey; William Whang; Jose Dizon; Marlon Rosenbaum |
Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing Volume: 28 ISSN: 1572-8595 ISO Abbreviation: J Interv Card Electrophysiol Publication Date: 2010 Aug |
Date Detail:
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Created Date: 2010-08-24 Completed Date: 2010-12-08 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9708966 Medline TA: J Interv Card Electrophysiol Country: Netherlands |
Other Details:
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Languages: eng Pagination: 125-35 Citation Subset: IM |
Affiliation:
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Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, NY, USA. ab542@columbia.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Atrial Flutter / epidemiology, etiology*, surgery* Catheter Ablation / methods* Electrophysiologic Techniques, Cardiac Female Humans Male Middle Aged Prevalence Recurrence Retrospective Studies Tetralogy of Fallot / complications*, surgery Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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