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Mechanism and Ablation of Arrhythmia Following Total Cavopulmonary Connection.


Circ Arrhythm Electrophysiol. 2015 Jan 12. pii: CIRCEP.114.001758.

Mechanism and Ablation of Arrhythmia Following Total Cavopulmonary Connection.

Correa R1Sherwin ED1Kovach J1Mah DY1Alexander ME1Cecchin F1Walsh EP1Triedman JK1Abrams DJ2.

 

Abstract

BACKGROUND:

-The ability to identify and ablate different arrhythmia mechanisms following the total cavopulmonary connection (TCPC) has not been studied in detail.

METHODS AND RESULTS:

-After obtaining IRB approval according to institutional guidelines, consecutive patients following a TCPC undergoing electrophysiology study over a 6 year period were included (2006-2012). Arrhythmia mechanism was determined, and the procedural outcome was defined as complete, partial success, or failure. A 12-point arrhythmia severity score was calculated for each patient at baseline and on follow-up. Fifty-seven procedures were performed on 52 patients (18.4 ± 11.8 years; 53.0 ± 27.2kg). Access to the pulmonary venous atrium was necessary in 33 procedures, via fenestration (16) or transbaffle puncture (17) and in two cases an additional retrograde approach was used. In total, 80 arrhythmias were identified in 47 cases: macroreentrant (n=25) or focal atrial tachycardia (n=8), atrioventricular nodal reentry tachycardia (n=13), reentry via an accessory pathway (n=4) or via twin atrioventricular nodes (n=4), ventricular tachycardia (n=5), and undefined atrial tachycardia (n=21). Procedural outcome in 32 patients who underwent ablation was complete success (n=25), partial success (n=3), failure (n=3), or empiricablation (n=1). Following successful ablation there was a significant decrease in arrhythmia score over 18.2 (4 - 32) months follow-up, with a sustained trend even in the face of arrhythmia recurrence (50%).

CONCLUSIONS:

-Arrhythmia mechanism post TCPC is highly varied, encompassing simple and more complex substrates, documentation of which facilitates a strategic approach to invasive arrhythmia management. Despite the anatomical limitations successful and clinically meaningful ablationis possible.

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