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Intra-atrial re-entrant tachycardia in congenital heart disease: types and relation of isthmus to atrial voltage

2017; Oxford University Press; Volume: 20; Issue: 2 Linguagem: Inglês

10.1093/europace/eux250

1532-2092

Ivo Roca‐Luque, Nuria Rivas‐Gándara, Laura Dos, Jaume Francisco‐Pascual, Antònia Pijuan‐Domenech, Jordi Pérez‐Rodon, Mercè Subirana, Alba Santos Ortega, Berta Miranda, Ferran Rosés‐Noguer, Ignacio Ferreira‐González, Jaume Casaldàliga Ferrer, David García‐Dorado García, Àngel Moya Mitjans,

Cardiac pacing and defibrillation studies

Intra-atrial re-entrant tachycardia (IART) is a frequent and severe complication in patients with congenital heart disease (CHD). Cavotricuspid isthmus (CTI)-related IART is the most frequent mechanism. However, due to fibrosis and surgical scars, non-CTI-related IART is also frequent. The main objective of this study was to describe the types of IART and circuit locations and to define a cut-off value for unhealthy tissue in the atria. This observational study included all consecutive patients with CHD who underwent a first ablation procedure for IART from January 2009 to December 2015 (94 patients, 39.4% female, age: 36.55 ± 14.9 years, 40.4% with highly complex cardiac disease). During the study, 114 IARTs were ablated (1.21 ± 0.41 IARTs per patient). Cavotricuspid isthmus-related IART was the only arrhythmia in 51% (n = 48) of patients, non-CTI-related IART was the only mechanism in 27.7% (n = 26), and 21.3% of patients (n = 20) presented both types of IART. In cases of non-CTI-related IART, the most frequent location of IART isthmus was the lateral or posterolateral wall of the venous atria, and a voltage cut-off value for unhealthy tissue in the atria of 0.5 mV identified 95.4% of IART isthmus locations. In our population with a high proportion of complex CHD, CTI-related IART was the most frequent mechanism, although non-CTI-related IART was present in 49% of patients (alone or with concomitant CTI-related IART). A cut-off voltage of 0.5 mV could identify 95.4% of the substrates in non-CTI-related IART.