Simplified progressive approach for the ablation of scar related atrial macroreentrant tachycardias / Ablación de arritmias por macroreentrada auricular relacionadas con cicatriz posquirúrgica, mediante un abordaje escalonado

Introduction: Radiofrequency ablation of scar related right atrial flutter is challenging. Long procedures, prolonged fluoroscopic times and high percentages of recurrences are of concern. We present a simple and progressive approach based on a single electroanatomic map of the right atrium. Methods: Twenty-two consecutive patients with atrial flutter and history of cardiac surgery were included. An electrophysiologic study was performed to define localization (left or right) and cavo-tricuspid isthmus participation using entrainment mapping. After a critical isthmus was localized, ablation was performed with an external irrigated tip catheter with a power limit of 30 W. Potential ablation sites were confirmed by entrainment. Results: The predominant cardiopathy was atrial septal defect. All arrhythmias were localized in the right atrium; mean cycle length of the clinical flutter was 274 ± 31 ms. Only 40% had cavo-tricuspid isthmus participation. None of the patients with successful ablation had recurrences after 13 ± 9.4 months of follow-up. Conclusions: A progressive approach with only one activation/voltage CARTO® map of the atrium and ablation of all potential circuits is a highly effective method for ablating scar related macroreentrant atrial arrhythmias.

Introducción: La ablación con radiofrecuencia de flutter auricular relacionado con cicatrices posquirúrgicas es compleja. Procedimientos prolongados, con tiempos de fluoroscopia altos y una tasa de recurrencia elevada son problemas habituales. Mostramos un abordaje simple y progresivo basado en un solo mapa de cartografía electroanatómica de la aurícula derecha. Métodos: Se incluyeron 22 pacientes consecutivos con flutter auricular e historia de cirugía cardiaca. Se realizó estudio electrofisiológico para definir la localización del circuito de flutter (derecho o izquierdo) y la participación o no del istmo cavotricuspideo mediante encarrilamiento. Una vez localizado la zona de conducción lenta o critica del circuito, se realizó ablación con radiofrecuencia con catéter de irrigación externa a 30W. Posteriormente se llevó a cabo ablación de todos los circuitos potenciales. Resultados: La cardiopatía más dominante fue la comunicación interauricular. Todas las arritmias se localizaron en la aurícula derecha. El ciclo de flutter fue de 274 ± 31 ms. En solo 40% de los casos se demostró participación del istmo cavotricuspideo. No se observaron recurrencias de la arritmia durante un seguimiento de 13 ± 9.4 meses. Conclusiones: Este abordaje escalonado con un solo mapa CARTO® de activación/voltaje de la aurícula y la ablación de todos los circuitos potenciales es altamente efectivo para el tratamiento de arritmias por macrorreentrada relacionadas con cicatriz posquirúrgica.

Simplified progressive approach for the ablation of scar related atrial macroreentrant tachycardias.

INTRODUCTION: Radiofrequency ablation of scar related right atrial flutter is challenging. Long procedures, prolonged fluoroscopic times and high percentages of recurrences are of concern. We present a simple and progressive approach based on a single electroanatomic map of the right atrium. METHODS: Twenty-two consecutive patients with atrial flutter and history of cardiac surgery were included. An electrophysiologic study was performed to define localization (left or right) and cavo-tricuspid isthmus participation using entrainment mapping. After a critical isthmus was localized, ablation was performed with an external irrigated tip catheter with a power limit of 30 W. Potential ablation sites were confirmed by entrainment. RESULTS: The predominant cardiopathy was atrial septal defect. All arrhythmias were localized in the right atrium; mean cycle length of the clinical flutter was 274 ± 31 ms. Only 40% had cavo-tricuspid isthmus participation. None of the patients with successful ablation had recurrences after 13 ± 9.4 months of follow-up. CONCLUSIONS: A progressive approach with only one activation/voltage CARTO(®) map of the atrium and ablation of all potential circuits is a highly effective method for ablating scar related macroreentrant atrial arrhythmias.

[Incidence and clinical features of arrhythmias after surgical treatment of congenital heart disease]. / Incidencia y comportamiento clínico de las arritmias en pacientes con corrección quirúrgica de cardiopatías congénitas.

Congenital heart disease is associated with arrhythmias. Not only the congenital anatomic component but also the greater arrhythmogenic substrate related to surgical procedures is associated with the increased incidence of arrhythmias in these patients. In pediatric cardiology the study of these phenomena is becoming important and one factor associated with it is the longer follow up, which varies depending on the type of heart disease and arrhythmia. With the same impact, there are daily breakthroughs in diagnostic and treatment through pharmacological and interventional means. The incidence of arrhythmias in post-surgical patients with congenital heart disease is in constant increment, and this is related to the constant increment in the procedures, variety and frequency, as well as the long-term survival.

Incidencia y comportamiento clínico de las arritmias en pacientes con corrección quirúrgica de cardiopatías congénitas / Incidence and clinical features of arrhythmias after surgical treatment of congenital heart disease

Congenital heart disease is associated with arrhythmias. Not only the congenital anatomic component but also the greater arrhythmogenic substrate related to surgical procedures is associated with the increased incidence of arrhythmias in these patients. In pediatric cardiology the study of these phenomena is becoming important and one factor associated with it is the longer follow up, which varies depending on the type of heart disease and arrhythmia. With the same impact, there are daily breakthroughs in diagnostic and treatment through pharmacological and interventional means. The incidence of arrhythmias in post-surgical patients with congenital heart disease is in constant increment, and this is related to the constant increment in the procedures, variety and frequency, as well as the long-term survival.