Tr. Betts et al., Electrophysiological mapping and ablation of intra-atrial reentry tachycardia after Fontan surgery with the use of a noncontact mapping system, CIRCULATION, 102(4), 2000, pp. 419-425
Citations number
19
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Background-Atrial tachyarrhythmias are a complication of Fontan surgery. Co
nventional electrophysiological mapping and ablation techniques are limited
by the complex anatomic and surgical substrate and a high arrhythmia recur
rence rate. This study investigates the use of noncontact mapping to identi
fy arrhythmia circuits and guide ablation in Fontan patients.
Methods and Results-Eleven arrhythmias were recorded in 6 patients. Noncont
act mapping improved recognition of the anatomic and surgical substrate and
identified exit sites from zones of slow conduction in all clinical arrhyt
hmias. Radiofrequency linear lesions were targeted across these critical zo
nes in 5 patients. One patient underwent surgical cryotherapy. Although imm
ediate success was achieved in 3 of 5 patients with radiofrequency ablation
, 2 patients had a recurrence after a mean of 6.4 months of follow-up. The
patient who underwent cryoablation remains free of arrhythmias.
Conclusions-Noncontact mapping can identify arrhythmia circuits in the Font
an atrium and guide placement of ablation lesions. Arrhythmia recurrence is
high, possibly because of inadequate lesion creation rather than inaccurat
e mapping and lesion targeting.