title: Left-sided ablation of ventricular tachycardia in adults with repaired tetralogy of Fallot: a case series.
abstract: BACKGROUND
  Radiofrequency catheter ablation (RFCA) of ventricular tachycardia (VT) in repaired Tetralogy of Fallot focuses on isthmuses in the right ventricle but may be hampered by hypertrophied myocardium or prosthetic material. These patients may benefit from ablation at the left side of the ventricular septum.
  
  
  RESULTS
  Records from 28 consecutive repaired Tetralogy of Fallot patients from 2 centers who underwent VT ablation were reviewed. Ablation targeted anatomic isthmuses containing VT re-entry circuits, which were identified by 3-dimensional substrate, pace, and entrainment mapping. A left-sided approach was considered beneficial if (1) right-sided RFCA failed, (2) part of the circuit was mapped to the left side, and (3) left-sided RFCA resulted in isthmus transection and prevention of VT induction. In 4 of 28 patients (52±13 years; 75% men), inducible for 1.5 (quartiles, 1.0 - 2.0) VTs (335±58 ms), left-sided RFCA was performed. In 3 patients, RFCA at aortic sites terminated VT related to a septal isthmus and prevented reinduction. In 1 patient, with prior biventricular implantable cardioverter-defibrillator, diastolic activity was recorded at the left side of the septum in proximity to the His-bundle. RFCA prevented VT reinduction with anticipated complete atrioventricular block. The left-sided approach resulted in complete procedural success (transection of anatomic isthmus and noninducibility) and freedom of VT recurrence during follow-up (20±15 months) in all patients. Right-sided RFCA failure was likely because of septal hypertrophy in 2, overlying pulmonary homograft in 1, and overlying ventricular septal defect patch in 1.
  
  
  CONCLUSIONS
  Left-sided RFCA for VTs dependent on septal anatomic isthmuses improves ablation outcome in repaired Tetralogy of Fallot.
authors.affiliation: From the Departments of Cardiology, Cardiac Surgery and Anatomy, Leiden University Medical Centre, Leiden, The Netherlands (G.F.L.K., A.P.W., S.R.D.P., M.J.S., M.G.H., M.R.M.J., K.Z.); and Department of Cardiology, Brigham and Women's Hospital, Boston, MA (T.R., U.B.T., W.G.S.).
authors.forename: Gijsbert F L
authors.initials: GF
authors.lastname: Kapel
authors.affiliation: From the Departments of Cardiology, Cardiac Surgery and Anatomy, Leiden University Medical Centre, Leiden, The Netherlands (G.F.L.K., A.P.W., S.R.D.P., M.J.S., M.G.H., M.R.M.J., K.Z.); and Department of Cardiology, Brigham and Women's Hospital, Boston, MA (T.R., U.B.T., W.G.S.).
authors.forename: Tobias
authors.initials: T
authors.lastname: Reichlin
authors.affiliation: From the Departments of Cardiology, Cardiac Surgery and Anatomy, Leiden University Medical Centre, Leiden, The Netherlands (G.F.L.K., A.P.W., S.R.D.P., M.J.S., M.G.H., M.R.M.J., K.Z.); and Department of Cardiology, Brigham and Women's Hospital, Boston, MA (T.R., U.B.T., W.G.S.).
authors.forename: Adrianus P
authors.initials: AP
authors.lastname: Wijnmaalen
authors.affiliation: From the Departments of Cardiology, Cardiac Surgery and Anatomy, Leiden University Medical Centre, Leiden, The Netherlands (G.F.L.K., A.P.W., S.R.D.P., M.J.S., M.G.H., M.R.M.J., K.Z.); and Department of Cardiology, Brigham and Women's Hospital, Boston, MA (T.R., U.B.T., W.G.S.).
authors.forename: Usha B
authors.initials: UB
authors.lastname: Tedrow
authors.affiliation: From the Departments of Cardiology, Cardiac Surgery and Anatomy, Leiden University Medical Centre, Leiden, The Netherlands (G.F.L.K., A.P.W., S.R.D.P., M.J.S., M.G.H., M.R.M.J., K.Z.); and Department of Cardiology, Brigham and Women's Hospital, Boston, MA (T.R., U.B.T., W.G.S.).
authors.forename: Sebastiaan R D
authors.initials: SR
authors.lastname: Piers
authors.affiliation: From the Departments of Cardiology, Cardiac Surgery and Anatomy, Leiden University Medical Centre, Leiden, The Netherlands (G.F.L.K., A.P.W., S.R.D.P., M.J.S., M.G.H., M.R.M.J., K.Z.); and Department of Cardiology, Brigham and Women's Hospital, Boston, MA (T.R., U.B.T., W.G.S.).
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Schalij
authors.affiliation: From the Departments of Cardiology, Cardiac Surgery and Anatomy, Leiden University Medical Centre, Leiden, The Netherlands (G.F.L.K., A.P.W., S.R.D.P., M.J.S., M.G.H., M.R.M.J., K.Z.); and Department of Cardiology, Brigham and Women's Hospital, Boston, MA (T.R., U.B.T., W.G.S.).
authors.forename: Mark G
authors.initials: MG
authors.lastname: Hazekamp
authors.affiliation: From the Departments of Cardiology, Cardiac Surgery and Anatomy, Leiden University Medical Centre, Leiden, The Netherlands (G.F.L.K., A.P.W., S.R.D.P., M.J.S., M.G.H., M.R.M.J., K.Z.); and Department of Cardiology, Brigham and Women's Hospital, Boston, MA (T.R., U.B.T., W.G.S.).
authors.forename: Monique R M
authors.initials: MR
authors.lastname: Jongbloed
authors.affiliation: From the Departments of Cardiology, Cardiac Surgery and Anatomy, Leiden University Medical Centre, Leiden, The Netherlands (G.F.L.K., A.P.W., S.R.D.P., M.J.S., M.G.H., M.R.M.J., K.Z.); and Department of Cardiology, Brigham and Women's Hospital, Boston, MA (T.R., U.B.T., W.G.S.).
authors.forename: William G
authors.initials: WG
authors.lastname: Stevenson
authors.affiliation: From the Departments of Cardiology, Cardiac Surgery and Anatomy, Leiden University Medical Centre, Leiden, The Netherlands (G.F.L.K., A.P.W., S.R.D.P., M.J.S., M.G.H., M.R.M.J., K.Z.); and Department of Cardiology, Brigham and Women's Hospital, Boston, MA (T.R., U.B.T., W.G.S.). K.Zeppenfeld@lumc.nl.
authors.forename: Katja
authors.initials: K
authors.lastname: Zeppenfeld
mesh_terms: D000200:Action Potentials; D000328:Adult; D000368:Aged; D002304:Cardiac Pacing, Artificial; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006352:Heart Ventricles / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011237:Predictive Value of Tests; D012086:Reoperation; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D013771:Tetralogy of Fallot / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right
keywords: Tetralogy of Fallot; catheter ablation; tachycardia