Catheter ablation of supraventricular tachyarrhythmia after extracardiac Fontan surgery

Jeremy P. Moore, Kevin M. Shannon, Frank A. Fish, Stephen P. Seslar, Jason M. Garnreiter, Ulrich Krause, Ronn E. Tanel, Andrew A. Papez, Thomas A. Pilcher, Seshadri Balaji

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: Extracardiac total cavopulmonary connection (E-TCPC) is widely performed for single ventricle palliation, yet there is little experience with catheter ablation in this population. Objectives: We hypothesized that atrial tachycardia substrates after primary E-TCPC would be similar to those in other forms of congenital heart disease and that catheter ablation could be performed effectively using a primarily transconduit approach. Methods: Catheter ablation characteristics of patients with E-TCPC from 9 centers were collected. Acute procedural success was defined as elimination of all sustained supraventricular tachyarrhythmias. Procedural complications, acute success, and recurrences were assessed. Results: Forty-six catheter ablation procedures were performed in 36 patients. Access to the atrium was by transconduit puncture in 29 procedures (63%). The most common supraventricular tachyarrhythmia mechanism was intra-atrial reentrant tachycardia (IART) in 21 patients (58%); and for all patients with primary E-TCPC and IART, an isthmus between the atrioventricular valve annulus and the oversewn inferior vena cava was critical for maintenance of tachycardia. Overall, acute success was achieved in 38 procedures (83%). There were 8 complications, with only 1 requiring intervention (epicardial pacemaker) and none related to conduit puncture. Recurrence after the final procedure occurred in 6 patients (17%) over a median follow-up duration of 0.4 years (interquartile range 0.1-1.5 years). Conclusion: Catheter ablation could be performed effectively in this group of patients with E-TCPC, and the underlying IART substrate after primary E-TCPC appears to be reproducible. Catheter ablation may be a reasonable alternative to long-term antiarrhythmic therapy in this patient group.

Original languageEnglish (US)
JournalHeart Rhythm
DOIs
StateAccepted/In press - 2016

Fingerprint

Catheter Ablation
Tachycardia
Punctures
Cardiac Catheters
Recurrence
Inferior Vena Cava
Heart Diseases
Maintenance
Population

Keywords

  • Catheter ablation
  • Congenital heart disease
  • Fontan operation
  • Intra-atrial reentrant tachycardia
  • Supraventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Moore, J. P., Shannon, K. M., Fish, F. A., Seslar, S. P., Garnreiter, J. M., Krause, U., ... Balaji, S. (Accepted/In press). Catheter ablation of supraventricular tachyarrhythmia after extracardiac Fontan surgery. Heart Rhythm. https://doi.org/10.1016/j.hrthm.2016.05.019

Catheter ablation of supraventricular tachyarrhythmia after extracardiac Fontan surgery. / Moore, Jeremy P.; Shannon, Kevin M.; Fish, Frank A.; Seslar, Stephen P.; Garnreiter, Jason M.; Krause, Ulrich; Tanel, Ronn E.; Papez, Andrew A.; Pilcher, Thomas A.; Balaji, Seshadri.

In: Heart Rhythm, 2016.

Research output: Contribution to journalArticle

Moore, JP, Shannon, KM, Fish, FA, Seslar, SP, Garnreiter, JM, Krause, U, Tanel, RE, Papez, AA, Pilcher, TA & Balaji, S 2016, 'Catheter ablation of supraventricular tachyarrhythmia after extracardiac Fontan surgery', Heart Rhythm. https://doi.org/10.1016/j.hrthm.2016.05.019
Moore, Jeremy P. ; Shannon, Kevin M. ; Fish, Frank A. ; Seslar, Stephen P. ; Garnreiter, Jason M. ; Krause, Ulrich ; Tanel, Ronn E. ; Papez, Andrew A. ; Pilcher, Thomas A. ; Balaji, Seshadri. / Catheter ablation of supraventricular tachyarrhythmia after extracardiac Fontan surgery. In: Heart Rhythm. 2016.
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abstract = "Background: Extracardiac total cavopulmonary connection (E-TCPC) is widely performed for single ventricle palliation, yet there is little experience with catheter ablation in this population. Objectives: We hypothesized that atrial tachycardia substrates after primary E-TCPC would be similar to those in other forms of congenital heart disease and that catheter ablation could be performed effectively using a primarily transconduit approach. Methods: Catheter ablation characteristics of patients with E-TCPC from 9 centers were collected. Acute procedural success was defined as elimination of all sustained supraventricular tachyarrhythmias. Procedural complications, acute success, and recurrences were assessed. Results: Forty-six catheter ablation procedures were performed in 36 patients. Access to the atrium was by transconduit puncture in 29 procedures (63{\%}). The most common supraventricular tachyarrhythmia mechanism was intra-atrial reentrant tachycardia (IART) in 21 patients (58{\%}); and for all patients with primary E-TCPC and IART, an isthmus between the atrioventricular valve annulus and the oversewn inferior vena cava was critical for maintenance of tachycardia. Overall, acute success was achieved in 38 procedures (83{\%}). There were 8 complications, with only 1 requiring intervention (epicardial pacemaker) and none related to conduit puncture. Recurrence after the final procedure occurred in 6 patients (17{\%}) over a median follow-up duration of 0.4 years (interquartile range 0.1-1.5 years). Conclusion: Catheter ablation could be performed effectively in this group of patients with E-TCPC, and the underlying IART substrate after primary E-TCPC appears to be reproducible. Catheter ablation may be a reasonable alternative to long-term antiarrhythmic therapy in this patient group.",
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T1 - Catheter ablation of supraventricular tachyarrhythmia after extracardiac Fontan surgery

AU - Moore, Jeremy P.

AU - Shannon, Kevin M.

AU - Fish, Frank A.

AU - Seslar, Stephen P.

AU - Garnreiter, Jason M.

AU - Krause, Ulrich

AU - Tanel, Ronn E.

AU - Papez, Andrew A.

AU - Pilcher, Thomas A.

AU - Balaji, Seshadri

PY - 2016

Y1 - 2016

N2 - Background: Extracardiac total cavopulmonary connection (E-TCPC) is widely performed for single ventricle palliation, yet there is little experience with catheter ablation in this population. Objectives: We hypothesized that atrial tachycardia substrates after primary E-TCPC would be similar to those in other forms of congenital heart disease and that catheter ablation could be performed effectively using a primarily transconduit approach. Methods: Catheter ablation characteristics of patients with E-TCPC from 9 centers were collected. Acute procedural success was defined as elimination of all sustained supraventricular tachyarrhythmias. Procedural complications, acute success, and recurrences were assessed. Results: Forty-six catheter ablation procedures were performed in 36 patients. Access to the atrium was by transconduit puncture in 29 procedures (63%). The most common supraventricular tachyarrhythmia mechanism was intra-atrial reentrant tachycardia (IART) in 21 patients (58%); and for all patients with primary E-TCPC and IART, an isthmus between the atrioventricular valve annulus and the oversewn inferior vena cava was critical for maintenance of tachycardia. Overall, acute success was achieved in 38 procedures (83%). There were 8 complications, with only 1 requiring intervention (epicardial pacemaker) and none related to conduit puncture. Recurrence after the final procedure occurred in 6 patients (17%) over a median follow-up duration of 0.4 years (interquartile range 0.1-1.5 years). Conclusion: Catheter ablation could be performed effectively in this group of patients with E-TCPC, and the underlying IART substrate after primary E-TCPC appears to be reproducible. Catheter ablation may be a reasonable alternative to long-term antiarrhythmic therapy in this patient group.

AB - Background: Extracardiac total cavopulmonary connection (E-TCPC) is widely performed for single ventricle palliation, yet there is little experience with catheter ablation in this population. Objectives: We hypothesized that atrial tachycardia substrates after primary E-TCPC would be similar to those in other forms of congenital heart disease and that catheter ablation could be performed effectively using a primarily transconduit approach. Methods: Catheter ablation characteristics of patients with E-TCPC from 9 centers were collected. Acute procedural success was defined as elimination of all sustained supraventricular tachyarrhythmias. Procedural complications, acute success, and recurrences were assessed. Results: Forty-six catheter ablation procedures were performed in 36 patients. Access to the atrium was by transconduit puncture in 29 procedures (63%). The most common supraventricular tachyarrhythmia mechanism was intra-atrial reentrant tachycardia (IART) in 21 patients (58%); and for all patients with primary E-TCPC and IART, an isthmus between the atrioventricular valve annulus and the oversewn inferior vena cava was critical for maintenance of tachycardia. Overall, acute success was achieved in 38 procedures (83%). There were 8 complications, with only 1 requiring intervention (epicardial pacemaker) and none related to conduit puncture. Recurrence after the final procedure occurred in 6 patients (17%) over a median follow-up duration of 0.4 years (interquartile range 0.1-1.5 years). Conclusion: Catheter ablation could be performed effectively in this group of patients with E-TCPC, and the underlying IART substrate after primary E-TCPC appears to be reproducible. Catheter ablation may be a reasonable alternative to long-term antiarrhythmic therapy in this patient group.

KW - Catheter ablation

KW - Congenital heart disease

KW - Fontan operation

KW - Intra-atrial reentrant tachycardia

KW - Supraventricular tachycardia

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