Targeted cluster ablation of non-CTI-dependent atrial arrhythmias in congenital heart disease using ultrahigh-definition mapping.
J Cardiovasc Electrophysiol
; 33(5): 932-942, 2022 05.
Article
en En
| MEDLINE
| ID: mdl-35224802
ABSTRACT
BACKGROUND:
Ablation of atrial arrhythmias in patients with congenital heart disease (CHD) has markedly improved with advanced mapping systems. However, recurrence rates remain high. The linear ablation strategy is not uncommonly practiced necessitating prolonged ablation times. We report the outcomes of adopting a strategy of minimal, cluster delivery of radiofrequency (RF) energy at critical substrates identified by ultrahigh-definition mapping for atrial arrhythmias in patients with CHD.METHODS:
Non-cavotricuspid isthmus (non-CTI) atrial tachycardias were ablated with a targeted ablation cluster technique (TACT) using an ultrahigh-density mapping system combined with multielectrode monitoring and endpoint determination in preference to linear ablation. The arrhythmia substrates, RF times, and acute- and medium-term success rates were studied.RESULTS:
Fifty-eight tachycardias were mapped and ablated in 42 procedures 34 non-CTIs and 24 CTIs. A targeted ablation cluster was performed for non-CTI tachycardias, with a median ablation time of 3.1 min. In 53% of non-CTI tachycardias, arrhythmia termination was achieved with ≤2 RF applications. After a mean follow-up of 23.6 months, 27 (80%) patients were free of recurrent atrial arrhythmias. One of 34 targeted non-CTI tachycardia recurred, with a final success rate of 91%. Linear ablation was performed for CTI flutters with a median ablation time of 6.8 min (vs. non-CTIs, p = .006). Three of 21 tachycardias recurred due to reconnection of the ablation line but the final success rate was 100%.CONCLUSIONS:
The TACT approach for non-CTI atrial arrhythmias in congenital patients as guided by the ultrahigh-density mapping is an effective method with short ablation times and excellent medium-term outcomes.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Aleteo Atrial
/
Ablación por Catéter
/
Cardiopatías Congénitas
Tipo de estudio:
Diagnostic_studies
/
Etiology_studies
/
Prognostic_studies
Límite:
Humans
Idioma:
En
Año:
2022
Tipo del documento:
Article