Transbaffle catheter ablation of atrial re-entrant tachycardia within the pulmonary venous atrium in adult patients with congenital heart disease.
OBJECTIVE
Catheter ablation of atrial re-entrant tachycardia in patients after atrial switch procedure for transposition of the great arteries or with a Fontan circulation is technically challenging if the critical part of the re-entry circuit is located within the pulmonary venous atrium (PVA). We report our experience in transbaffle access (TBA) to the PVA for ablation of atrial re-entrant tachycardia focusing on technical details.


RESULTS
In eight patients, six after Mustard procedure and two with a Fontan circulation, endocardial mapping of atrial re-entrant tachycardia revealed the critical part of the re-entry circuit within the PVA. A total of 10 ablation procedures were performed. Detailed angiographic assessment of the anatomy of the systemic and pulmonary venous atria was performed prior to baffle puncture. Transbaffle access was successfully established with a standard transseptal needle in 9 of 10 procedures. No major complications occurred. At the end of the procedure and the removal of the transseptal sheath, there was no residual shunt in any patient.


CONCLUSIONS
Transbaffle access to the PVA for ablation of atrial re-entrant tachycardia is feasible, less invasive than alternative approaches and can be safely applied in patients after Mustard procedure or with a Fontan circulation. However, the rigidity of prosthetic material may preclude baffle puncture at least in a subset of those patients.
Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University of Göttingen, Robert- Koch-Str 40, Göttingen 37075, Germany ukrause1@gwdg.de.
Ulrich
U
Krause
Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University of Göttingen, Robert- Koch-Str 40, Göttingen 37075, Germany.
David
D
Backhoff
Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University of Göttingen, Robert- Koch-Str 40, Göttingen 37075, Germany.
Sophia
S
Klehs
Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University of Göttingen, Robert- Koch-Str 40, Göttingen 37075, Germany.
Heike E
HE
Schneider
Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University of Göttingen, Robert- Koch-Str 40, Göttingen 37075, Germany.
Thomas
T
Paul
D000328:Adult; D000792:Angiography; D017115:Catheter Ablation / Q000379:methods*; D004452:Echocardiography; D022062:Electrophysiologic Techniques, Cardiac; D004699:Endocardium / Q000503:physiopathology; D005260:Female; D018729:Fontan Procedure; D005858:Germany; D006325:Heart Atria / Q000503:physiopathology; D006801:Humans; D008297:Male; D011667:Pulmonary Veins / Q000601:surgery; D012189:Retrospective Studies; D013612:Tachycardia, Ectopic Atrial / Q000601:surgery*; D014188:Transposition of Great Vessels / Q000150:complications* / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
Atrial re-entrant tachycardia; Atrial switch procedure; Catheter ablation; Fontan; Pulmonary venous atrium; Transbaffle access