BACKGROUND: Prior investigators note successful ablation of both typical cavotricuspid isthmus-dependent and scar-related macroreentrant right atrial flutters (AFL) in adult patients with repaired tetralogy of Fallot (TOF). However, an analysis of the mechanisms (including a description of a uniform approach to diagnose such mechanisms), and clinical outcomes of catheter ablation in a consecutive series of adult patients with AFL late after surgical TOF repair has not been previously reported. METHODS: Background clinical data and follow-up were evaluated in a consecutive series of TOF patients evaluated from September 2001 to June 2008. RESULTS: We report a prevalence of sustained, symptomatic AFL in patients with repaired TOF equal to 20% (28/140 patients), and of recurrent, drug-refractory and/or severely symptomatic AFL to be 11% (16/140 patients). The AFLs manifested variable cycle lengths ranging from 215 to 525 ms. Underlying mechanisms were: (1) cavotricuspid (CTI)-dependent, counterclockwise atrial flutter (n=8 patients); (2) non-CTI-dependent macroreentrant scar-related AFL (n=6 patients); and (3) both CTI- and non-CTI-dependent macroreentrant AFL (n=2 patients). Recurrent arrhythmias occurred in six patients, five of whom were successfully treated with repeat ablation. After a mean follow-up of 23 months, 15 of 16 patients were alive and free of sustained AFL. CONCLUSIONS: AFL late after surgical TOF repair occurs in 20% of such patients. In more than half of these patients, the AFLs are drug-refractory and/or severely symptomatic. Despite the presence of congenital heart disease treated with prior cardiac surgery and AFLs with variable atrial cycle lengths, the CTI-dependent mechanism underlies approximately half of the sustained, symptomatic AFLs.
BACKGROUND: Prior investigators note successful ablation of both typical cavotricuspid isthmus-dependent and scar-related macroreentrant right atrial flutters (AFL) in adult patients with repaired tetralogy of Fallot (TOF). However, an analysis of the mechanisms (including a description of a uniform approach to diagnose such mechanisms), and clinical outcomes of catheter ablation in a consecutive series of adult patients with AFL late after surgical TOF repair has not been previously reported. METHODS: Background clinical data and follow-up were evaluated in a consecutive series of TOF patients evaluated from September 2001 to June 2008. RESULTS: We report a prevalence of sustained, symptomatic AFL in patients with repaired TOF equal to 20% (28/140 patients), and of recurrent, drug-refractory and/or severely symptomatic AFL to be 11% (16/140 patients). The AFLs manifested variable cycle lengths ranging from 215 to 525 ms. Underlying mechanisms were: (1) cavotricuspid (CTI)-dependent, counterclockwise atrial flutter (n=8 patients); (2) non-CTI-dependent macroreentrant scar-related AFL (n=6 patients); and (3) both CTI- and non-CTI-dependent macroreentrant AFL (n=2 patients). Recurrent arrhythmias occurred in six patients, five of whom were successfully treated with repeat ablation. After a mean follow-up of 23 months, 15 of 16 patients were alive and free of sustained AFL. CONCLUSIONS: AFL late after surgical TOF repair occurs in 20% of such patients. In more than half of these patients, the AFLs are drug-refractory and/or severely symptomatic. Despite the presence of congenital heart disease treated with prior cardiac surgery and AFLs with variable atrial cycle lengths, the CTI-dependent mechanism underlies approximately half of the sustained, symptomatic AFLs.
Authors: H Nakagawa; R Lazzara; T Khastgir; K J Beckman; J H McClelland; S Imai; J V Pitha; A E Becker; M Arruda; M D Gonzalez; L E Widman; M Rome; J Neuhauser; X Wang; J D Calame; M D Goudeau; W M Jackman Journal: Circulation Date: 1996-08-01 Impact factor: 29.690
Authors: H Nakagawa; N Shah; K Matsudaira; E Overholt; K Chandrasekaran; K J Beckman; P Spector; J D Calame; A Rao; C Hasdemir; K Otomo; Z Wang; R Lazzara; W M Jackman Journal: Circulation Date: 2001-02-06 Impact factor: 29.690
Authors: Petr Peichl; Josef Kautzner; Robert Cihák; Vlastimil Vancura; Jan Bytesník Journal: Pacing Clin Electrophysiol Date: 2003-01 Impact factor: 1.976
Authors: R J Kanter; J Papagiannis; M P Carboni; R M Ungerleider; W E Sanders; J M Wharton Journal: J Am Coll Cardiol Date: 2000-02 Impact factor: 24.094
Authors: G Kirkorian; E Moncada; P Chevalier; G Canu; J P Claudel; C Bellon; L Lyon; P Touboul Journal: Circulation Date: 1994-12 Impact factor: 29.690