Atrial reentrant tachycardia after surgery for congenital heart disease: endocardial mapping and radiofrequency catheter ablation using a novel, noncontact mapping system.
BACKGROUND
The purpose of the present study was to determine the role of a novel, noncontact mapping system for assessing a variety of atrial reentrant tachycardias (ART) in patients after the surgical correction of congenital heart disease.


RESULTS
In 14 patients, an electrophysiological study using the Ensite 3000 system was performed to assess ARTs resistant to medical treatment. Sixteen different forms of ART were inducible in the 14 patients studied. The reentrant circuit of all ARTs could be characterized and localized with respect to anatomic landmarks such as atriotomy scars, intraatrial patches/baffles, and cardiac structures. In 15 of the 16 ARTs (in 13 of the 14 patients), a target area of the reentrant circuit for radiofrequency current application (ie, an area of conduction between 2 anatomical obstacles such as surgical barriers and cardiac structures of electrical isolation) could be localized within the systemic venous atrium. Nine patients exhibited macroreentry, and 4 showed microreentry. In 12 patients, ART could be terminated by creating linear radiofrequency current lesions (75 degrees C, 180 to 390 s). Completeness of linear lesions after radiofrequency current delivery was proven by analyzing color-coded isopotential maps of atrial activation while applying atrial pacing techniques. The mean duration of the procedures was 286 minutes (range, 130 to 435 minutes); fluoroscopy time ranged from 7 to 33.8 minutes (mean, 17.4 minutes).


CONCLUSIONS
In patients with ART after the surgical correction of congenital heart disease, the use of the noncontact mapping system allows for characterization of the tachycardia and guidance for effective radiofrequency current delivery.
Paul
T
T
Department of Pediatric Cardiology, Hannover Medical School, Hannover, Germany. Paul.Thomas@MH-Hannover.De
Windhagen-Mahnert
B
B
Kriebel
T
T
Bertram
H
H
Kaulitz
R
R
Korte
T
T
Niehaus
M
M
Tebbenjohanns
J
J
D000293:Adolescent; D000328:Adult; D018780:Body Surface Potential Mapping / Q000295:instrumentation / Q000379:methods*; D002304:Cardiac Pacing, Artificial; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D017115:Catheter Ablation; D002648:Child; D022062:Electrophysiologic Techniques, Cardiac / Q000295:instrumentation / Q000379:methods; D005500:Follow-Up Studies; D006325:Heart Atria / Q000503:physiopathology / Q000601:surgery*; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D011237:Predictive Value of Tests; D013617:Tachycardia, Supraventricular / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome