Three-dimensional electroanatomical mapping of right periatriotomy tachycardias after interatrial defect correction.
BACKGROUND
Pericicatricial right intra-atrial reentrant tachycardias occur frequently in patients who have undergone surgical correction of an interatrial defect.


OBJECTIVE
To characterize the tachycardia circuits using three-dimensional electroanatomical mapping.


METHODS
Twelve tachycardias were analysed in 11 patients who had undergone surgical correction of an interatrial defect. Patients were divided into two groups: atrial flutter with typical sawtooth flutter waves in inferior leads, atrial tachycardia with clearly delimited P waves separated by an isoelectric line.


RESULTS
Seven tachycardias were classified as atrial flutter; three-dimensional mapping identified a peritricuspid circuit with inferior vena cava-tricuspid annulus isthmus involvement in all cases. All atrial flutters were terminated by linear ablation of this isthmus. Five tachycardias were classified as atrial tachycardia; three-dimensional mapping identified periatriotomy loops. All atrial tachycardias were ablated successfully between two scars or between a scar and an anatomical barrier.


CONCLUSIONS
Periatriotomy loops were always associated with an atrial tachycardia electrocardiogram pattern. Three-dimensional electroanatomical mapping appeared to be particularly useful for circuit identification and for ablation of these complex arrhythmias.
Halimi
Franck
F
Department of clinical electrophysiology, institut du coeur, hôpital Pitié-Salpêtrière, 75013 Paris, France. franck.halimi@club-internet.fr
Marquez
Manlio
M
Lacotte
Jérome
J
Hidden-Lucet
Françoise
F
Tonet
Joelci
J
Frank
Robert
R
D000328:Adult; D000368:Aged; D001282:Atrial Flutter / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D018780:Body Surface Potential Mapping / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D017115:Catheter Ablation; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology* / Q000601:surgery; D006344:Heart Septal Defects, Atrial / Q000601:surgery*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D013617:Tachycardia, Supraventricular / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000601:surgery