title: Catheter ablation of tachycardia arising from the pulmonary venous atrium after surgical repair of congenital heart disease.
abstract: BACKGROUND
  Tachycardia arising from the pulmonary venous atrium (PVA) has not been adequately characterized in the setting of surgically repaired congenital heart disease (CHD).
  
  
  OBJECTIVE
  The purpose of this study was to determine the mechanisms, approach, and outcomes of catheter ablation of PVA tachycardia after CHD repair.
  
  
  METHODS
  The adult CHD procedural database was searched for consecutive ablation procedures over a 4-year period. Procedural characteristics of the population with tachycardia arising from the PVA were compared to those without PVA tachycardia. Groups were classified as (1) biventricular CHD, (2) single ventricle, or (3) d-transposition of the great arteries (DTGA)-baffle.
  
  
  RESULTS
  Complete 3-dimensional mapping was possible for 113 of 124 sustained tachycardias during 81 procedures. Of these, 31 (19%) arose from the PVA, including 11 (15%) tachycardias in biventricular CHD, 8 (31%) in single ventricle, and 12 (80%) in DTGA-baffle procedures. Intra-atrial reentrant tachycardia was less frequently observed in the PVA vs the systemic venous atrium (SVA) (P = .012). Independent predictors of PVA tachycardia were absence of biventricular CHD (odds ratio 0.19, confidence interval 0.05-0.64, P = .010) and ipsilateral atrial surgery (odds ratio 15.7, confidence interval 4.8-59.9, P <.001). PVA procedure duration was greater than SVA-only procedures (median 5.3 hours vs 4.0 hours, P = .012), but acute success was similar (87% vs 82%, respectively, P = NS).
  
  
  CONCLUSIONS
  PVA tachycardia is not unusual after surgical repair of CHD. Predictors include ipsilateral atrial surgery and absence of biventricular CHD. Such procedures involve increased complexity and unique tachycardia substrates but appear equally amenable to catheter ablation.
authors.affiliation: Division of Pediatric Cardiology, UCLA Medical Center, Los Angeles, California; Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California. Electronic address: jpmoore@mednet.ucla.edu.
authors.forename: Jeremy P
authors.initials: JP
authors.lastname: Moore
authors.affiliation: Division of Pediatric Cardiology, UCLA Medical Center, Los Angeles, California.
authors.forename: Matthew
authors.initials: M
authors.lastname: Russell
authors.affiliation: Division of Pediatric Cardiology, Loma Linda University Medical Center, Los Angeles, California; UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California.
authors.forename: Ravi
authors.initials: R
authors.lastname: Mandapati
authors.affiliation: Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California.
authors.forename: Jamil A
authors.initials: JA
authors.lastname: Aboulhosn
authors.affiliation: Division of Pediatric Cardiology, UCLA Medical Center, Los Angeles, California; Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Shannon
mesh_terms: D000328:Adult; D006348:Cardiac Surgical Procedures; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000503:physiopathology / Q000601:surgery*; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006330:Heart Defects, Congenital / Q000150:complications / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D013617:Tachycardia, Supraventricular / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Catheter ablation; Congenital heart disease; Left atrium; Pulmonary venous atrium; Supraventricular tachycardia