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Ablation of atrial tachyarrhythmias late after surgical repair of tetralogy of Fallot

Published online by Cambridge University Press:  27 October 2010

Dan Raine ,
John O’Sullivan ,
Milind Chaudhari ,
Leslie Hamilton ,
Asif Hasan  and
John P. Bourke
Dan Raine
Affiliation:
Department of Adult, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, United Kingdom
John O’Sullivan
Affiliation:
Department of Paediatric, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, United Kingdom
Milind Chaudhari
Affiliation:
Department of Paediatric, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, United Kingdom
Leslie Hamilton
Affiliation:
Department of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, United Kingdom
Asif Hasan
Affiliation:
Department of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, United Kingdom
John P. Bourke*
Affiliation:
Department of Adult, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, United Kingdom
*
Correspondence to: Dr J. P. Bourke, Consultant & Senior Lecturer in Cardiology, Department of Cardiology, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne NE7 7DN, United Kingdom. Tel: +44 191 2137131; Fax: +44 191 2231400; E-mail: john.bourke@nuth.nhs.uk
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Abstract

Background

Patients with repaired tetralogy of Fallot may develop symptomatic and haemodynamic deterioration for many reasons such as arrhythmia, pulmonary regurgitation, and impairment in ventricular function. We describe a consecutive group of patients whose main clinical problem was atrial tachyarrhythmias.

Aims

To describe the clinical outcome of atrial tachyarrhythmias occurring late after surgical repair of tetralogy of Fallot; to define the circuits/foci responsible for these atrial tachyarrhythmias; to evaluate the outcome of computer-assisted mapping and catheter ablation in this patient group.

Methods and results

Consecutive patients with surgically repaired tetralogy of Fallot and atrial tachyarrhythmias, who underwent catheter ablation between January, 2001 and June, 2007, were identified retrospectively from case records. Computer-assisted mapping was performed in all using either EnSite® (St Jude Medical Inc.) arrhythmia mapping and intra-cardiac catheter guidance system or CARTO™ (Biosense Webster Inc.) electroanatomical mapping systems. Ten patients (four males) with a median age of 39 plus or minus 8 years were studied. The total number of atrial tachyarrhythmias identified was 22 (six macro-reentrant, 16 micro-reentrant/focal). In nine patients, catheter ablation led to improvement in arrhythmia episodes and/or symptoms during follow-up of 41 plus or minus 20 months. Following ablation(s), five patients required pacing for pre-existing conduction disease and five needed further surgery for haemodynamic indications. All patients remained on anti-arrhythmic drugs.

Conclusions

Patients with surgically repaired tetralogy of Fallot and atrial tachyarrhythmias typically have multiple arrhythmic circuits/foci arising from a scarred right atrium. Catheter ablation reduces arrhythmia frequency and improves symptoms. However, hybrid management is often required, comprising drugs, pacing, and further surgery tailored to the individual.

Keywords

Congenital cardiac diseaseCARTO™EnSite®mapping
Type
Original Articles
Information
Cardiology in the Young , Volume 21 , Issue 1 , February 2011 , pp. 31 - 38
Copyright
Copyright © Cambridge University Press 2010

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