title: Radio-frequency ablation of arrhythmias following congenital heart surgery.
abstract: BACKGROUND
  Cardiac arrhythmias as a late complication following congenital heart surgery are encountered more and more frequently in clinical practice. The use of new electrophysiological methods of visualisation and mapping improves the efficacy of radio-frequency (RF) ablation of these arrhythmias.
  
  
  OBJECTIVE
  To assess patterns of atrial arrhythmias following congenital heart surgery and to examine the efficacy of RF ablation using the electro-anatomical CARTO system.
  
  
  METHODS
  Electrophysiological diagnostic study and RF ablation were performed in 24 consecutive patients (mean age 36+/-18 years) who had atrial arrhythmias following congenital heart surgery. The mechanism of arrhythmia (ectopic or reentrant) and strategy of RF ablation procedure were based on the results of the right atrial map performed during index arrhythmia.
  
  
  RESULTS
  The patients were divided into five groups according to the type of congenital heart surgery. The ASD group consisted of 17 patients who had undergone in the past surgery due to atrial septal defect, four patients had a history of surgery due to ventricular septal defect (VSD group), and one patient each had undergone surgery due to corrected transposition of the great arteries (ccTGA), tetralogy of Fallot (TF) or dual-outflow right ventricle (DORV). During diagnostic electrophysiological study typical atrial flutter (AFL) was diagnosed in nine patients from the ASD group, atypical AFL in three ASD patients, and ectopic atrial tachycardia (EAT) in six ASD patients. In one patient EAT was induced after ablation of typical AFL. Of the VSD patients, three had atypical AFL, and one had typical AFL. The patient following surgery for ccTGA had atypical AFL and EAT, whereas in the two remaining patients (DORV and TF) atypical AFL was demonstrated. The efficacy of the first session of RF ablation was 83% and no complications were observed. The efficacy of RF ablation of typical AFL was 90%, atypical AFL 78%, and EAT 86% (NS). During the long-term follow-up (24+/-17 months) arrhythmia recurrences were noted in 2 (10%) out of 20 patients who were effectively treated during the first RF ablation session.
  
  
  CONCLUSIONS
  Reentry is the most common electrophysiological mechanism of incisional tachycardias, followed by ectopic atrial tachycardia. RF ablation using the electro-anatomical CARTO system is effective and safe in this group of patients.
authors.affiliation: Slaskie Centrum Chorób Serca, ul. Szpitalna 2, 41-800 Zabrze. karzab@infomed.slam.katowice.pl
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Kalarus
authors.forename: Oskar
authors.initials: O
authors.lastname: Kowalski
authors.forename: Radosław
authors.initials: R
authors.lastname: Lenarczyk
authors.forename: Patrycja
authors.initials: P
authors.lastname: Pruszkowska-Skrzep
authors.forename: Sławomir
authors.initials: S
authors.lastname: Pluta
authors.forename: Bozena
authors.initials: B
authors.lastname: Zeifert
authors.forename: Beata
authors.initials: B
authors.lastname: Chodór
authors.forename: Jacek
authors.initials: J
authors.lastname: Białkowski
authors.forename: Janusz
authors.initials: J
authors.lastname: Skalski
authors.forename: Marian
authors.initials: M
authors.lastname: Zembala
mesh_terms: D000328:Adult; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D018780:Body Surface Potential Mapping; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D017115:Catheter Ablation; D004562:Electrocardiography; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013610:Tachycardia / Q000209:etiology / Q000503:physiopathology; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents