5 Here, we present a patient with D-TGA, systemic ventricular failure, severely deformed atrial baffle, and recurrent near-syncope related to sustained narrow complex tachycardia. This allows for not only a real-time 3D image acquisition but can also provide needed anatomic details for certain ablations. More recently, a new imaging addition is the use of two-dimensional (2D) intracardiac echocardiograpy (ICE) image slices, which are manually reconstructed into three-dimensional (3D) images and merged with preprocedure cardiac CT or MRI. 4 Therefore, SVT suppression for individuals with atrial redirective reconstructive surgery with systemic ventricular failure is of extreme importance.Īdvanced cardiac imaging, such as computed tomography (CT) and cardiac magnetic resonance imaging (MRI) merged with electroanatomic mapping, has been utilized to assist with complex ablations. Data from implantable cardioverter-defibrillator (ICD) registries of D-TGA patients indicate that SVT often coexists or precipitates malignant ventricular arrhythmias leading to ICD therapy or SCD. Additionally, supraventricular tachycardia (SVT) is considered to be a risk factor for the development of ventricular arrhythmias and SCD. 1– 3 Etiology of SCD has been attributed to tachyarrhythmias rather than bradyarrhythmias, given the observation that patients with D-TGA and pacemakers are not protected from SCD. By the time individuals reach the second to fourth decade of life, systemic ventricular failure, baffle leaks or obstruction, atrial arrhythmias, ventricular arrhythmias, and sudden cardiac death (SCD) can result. Individuals with complete transposition of the great arteries (D-TGA) following atrial redirective reconstructive surgery, such as a Mustard or Senning baffle, can develop a multitude of late complications. Eckhardt, MD, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, H6/343 CSC, Madison, WI 53792. Manuscript received August 26, 2010, final version accepted September 20, 2010.Īddress correspondence to: Lee L. The authors report no conflicts of interest for the published content. D-TGA, catheter ablation, atrial flutter, ultrasound-guided imaging, intracardiac electroanatomic mapping. ECKHARDT, MD and CESAR ALBERTE, MDĭivision of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI © The Author 2015.Catheter Ablation for D-TGA Related Atrial Flutter Using Intracardiac Guided Echocardiography Published on behalf of the European Society of Cardiology. Maintenance of bidirectional MAL block was shown in 58% of patients during a repeat ablation.Īblation Atypical flutter Line Modified anterior linie Perimitral flutter. The MAL is effective for acute and long-term treatment of PMFL. Persistent MAL block was demonstrated in 22 of 38 (58%) patients during the repeat ablation. During reablation, 13 of 38 (34%) patients were identified to have a PMFL recurrence. During follow-up (16 ± 7 months), 38 of 77 (49%) patients underwent a repeat procedure for a recurrent arrhythmia. In five patients an additional MI line was necessary to terminate PMFL and in four patients both lines failed to achieve termination. Acute success was achieved in 68 of 77 patients (88%) without difference between the three groups. Acute success was defined as PMFL termination during MAL deployment with demonstration of bidirectional line block. Perimitral atrial flutter was either the presenting arrhythmia after persistent atrial fibrillation (AF) ablation (Group 1, n = 42, 54.5%), occurring during AF ablation (Group 2, n = 25, 35%) or presenting as primary arrhythmia (Group 3, n = 8, 10%). ![]() The anterior line was deployed between the anterolateral mitral annulus and the ostium of the left superior pulmonary vein. The cohort included 77 consecutive patients who underwent catheter ablation of PMFL. We sought to investigate acute and long-term efficacy of this line if routinely used for PMFL. The modified anterior line (MAL) is an alternative to the mitral isthmus (MI) line for the treatment of perimitral atrial flutter (PMFL).
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |