Simplified demonstration of cavotricuspid isthmus block after catheter ablation in patients after Mustard's operation.
BACKGROUND
The Mustard operation is a complex atrial rerouting performed in patients with transposition of the great arteries (TGA). Cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL) is an important problem in these patients. While catheter ablation (CA) is successful, three-dimensional (3D) mapping is necessary to prove block at the CTI. 3D mapping, however, requires baffle puncture. We tested a simplified concept to prove isthmus block after CA for AFL in Mustard patients.


METHODS
During electrophysiology study, catheters were placed in the high and low systemic venous atrium (HSVA and LSVA) and in the low pulmonary venous atrium (LPVA). LPVA and then LSVA were paced while recording in the HSVA and the alternate site. While pacing from one low site, the time taken to activate the other low site and the HSVA was compared before and after successful ablation.


RESULTS
Three patients with Mustard operation and AFL underwent successful CA. Involvement of the CTI in AFL was proved by entrainment mapping. AFL was terminated during ablation and no longer inducible after ablation in all. LSVA pacing showed LPVA activation preceded HSVA activation preablation and activation pattern reversal after ablation. Likewise, LPVA pacing showed LSVA activation preceding HSVA preablation with reversal after ablation.


CONCLUSIONS
This study provides a simple method to demonstrate bidirectional block at the CTI in patients with CTI-based AFL after Mustard operation for TGA.
Department of Pediatrics-Cardiology, Oregon Health and Science University, Portland, Oregon 97239, USA. balajis@ohsu.edu
Seshadri
S
Balaji
Karl C
KC
Stajduhar
Ignatius G
IG
Zarraga
Jack
J
Kron
D000328:Adult; D001282:Atrial Flutter / Q000209:etiology* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006327:Heart Block / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D008297:Male; D009204:Myocardial Revascularization / Q000009:adverse effects*; D014188:Transposition of Great Vessels / Q000150:complications* / Q000601:surgery*; D016896:Treatment Outcome