Very long-term results of electroanatomic-guided radiofrequency ablation of atrial arrhythmias in patients with surgically corrected atrial septal defect.
OBJECTIVE
Atrial tachycardias are common after repair of atrial septal defect (ASD). Although ablation has shown promising results in the short and mid-term follow-up, little data regarding the very long-term success exist. Our aim was to assess very long-term follow-up in patients who have undergone electroanatomic-guided radiofrequency (RF) ablation of late-onset atrial arrhythmias after ASD surgery.


RESULTS
Forty-six consecutive patients with surgically repaired ASD were referred for atrial tachycardia ablation. Electrophysiological (EP) study and ablation procedure with the aid of an electroanatomic mapping (EAM) system were performed. Mean age was 49 ± 13 years (females 61%). The presenting arrhythmias were typical atrial flutter (48%), atypical atrial flutter (35%), and atrial tachycardia (17%). In 41% of patients, atrial fibrillation was also present. The EP study showed a right atrial macroreentrant circuit in all the patients. In 12 of 46 (26%), the circuit was localized in the cavo-tricuspid isthmus, whereas in the remaining 34 patients (74%) was atriotomy-dependent. Acute success was 100%. Clinical arrhythmia recurred in 24% of the patients. Nine patients underwent a second and two a third ablation procedure, reaching an overall efficacy of 87% (40 of 46) at a mean follow-up of 7.3 ± 3.8 years since the last procedure. With antiarrhythmic drugs the success rate increased to 96% (44 of 46). No complications occurred.


CONCLUSIONS
In patients with surgically corrected ASD, EAM-guided RF ablation of late-onset macroreentrant atrial arrhythmias demonstrated a high success rate in a very long-term follow-up. Therefore, RF ablation could be considered early in the management of late-onset macroreentrant atrial tachycardias.
Cardiology Division, Cardinal Massaia Hospital, Corso Dante 202, Asti 14100, Italy marco.scaglione@tin.it.
Marco
M
Scaglione
Cardiology Division, Cardinal Massaia Hospital, Corso Dante 202, Asti 14100, Italy.
Domenico
D
Caponi
Cardiology Division, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88, Turin 10126, Italy.
Elisa
E
Ebrille
Cardiology Division, Cardinal Massaia Hospital, Corso Dante 202, Asti 14100, Italy.
Paolo
P
Di Donna
Cardiology Division, Cardinal Massaia Hospital, Corso Dante 202, Asti 14100, Italy.
Francesca
F
Di Clemente
Cardiology Division, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88, Turin 10126, Italy.
Alberto
A
Battaglia
Cardiology Division, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88, Turin 10126, Italy.
Cristina
C
Raimondo
Cardiology Division, Cardinal Massaia Hospital, Corso Dante 202, Asti 14100, Italy.
Manuela
M
Appendino
Cardiology Division, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88, Turin 10126, Italy.
Fiorenzo
F
Gaita
D001281:Atrial Fibrillation / Q000175:diagnosis / Q000601:surgery*; D001282:Atrial Flutter / Q000175:diagnosis / Q000601:surgery*; D018780:Body Surface Potential Mapping; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000601:surgery*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome
Ablation; Atrial septal defect; Incisional tachycardias; Long-term follow-up