Document Detail

Dual-loop circuits in postoperative atrial macro re-entrant tachycardias.
MedLine Citation:
PMID:  16980513     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Patients may develop dual-loop re-entrant atrial arrhythmias late after open-heart surgery, and mapping and catheter ablation remain challenging despite computer-assisted mapping techniques. OBJECTIVES: The purpose of the study was to demonstrate the prevalence and characteristics of dual-loop re-entrant arrhythmias, and to define the optimal mapping and ablation strategy. METHODS: 40 consecutive patients (mean (SD) age 52 (12) years) with intra-atrial re-entrant tachycardia (IART) after open-heart surgery (with an incision of the right atrial free wall) were studied. Dual-loop IART was defined as the presence of two simultaneous atrial circuits. After an abrupt tachycardia change during radiofrequency ablation, electrical disconnection of the targeted re-entry isthmus from the remaining circuit was demonstrated by entrainment mapping. Furthermore, the second circuit loop was localised using electroanatomical mapping and/or entrainment mapping. RESULTS: Dual-loop IART was demonstrated in eight (20%, 5 patients with congenital heart disease, 3 with acquired heart disease) patients. Dual-loop IART included an isthmus-dependant atrial flutter combined with a re-entry related to the atriotomy scar. The diagnosis of dual-loop IART required the comparison of entrainment mapping before and after tachycardia modification. Overall, 35 patients had successful radiofrequency ablation (88%). Success rates were lower in patients with dual-loop IART than in patients without dual-loop IART. Ablation failures in three patients with dual-loop IART were related to the inability to properly transect the second tachycardia isthmus in the right atrial free wall. CONCLUSIONS: Dual-loop IART is relatively common after heart surgery involving a right atriotomy. Abrupt tachycardia change and specific entrainment mapping manoeuvres demonstrate these circuits. Electroanatomical mapping appears to be important to assist catheter ablation of periatriotomy circuits.
Jens Seiler; Dorothy K Schmid; Thiemo A Irtel; Hildegard Tanner; Martin Rotter; Nicola Schwick; Etienne Delacrétaz
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2006-09-15
Journal Detail:
Title:  Heart (British Cardiac Society)     Volume:  93     ISSN:  1468-201X     ISO Abbreviation:  Heart     Publication Date:  2007 Mar 
Date Detail:
Created Date:  2007-02-26     Completed Date:  2007-04-17     Revised Date:  2010-09-14    
Medline Journal Info:
Nlm Unique ID:  9602087     Medline TA:  Heart     Country:  England    
Other Details:
Languages:  eng     Pagination:  325-30     Citation Subset:  AIM; IM    
Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland.
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MeSH Terms
Cardiac Surgical Procedures / adverse effects*
Catheter Ablation / methods
Diagnosis, Differential
Electrophysiology / methods
Follow-Up Studies
Middle Aged
Postoperative Care / methods
Tachycardia, Atrioventricular Nodal Reentry / etiology*,  physiopathology,  surgery
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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