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. 2007 Mar;93(3):325-30.
doi: 10.1136/hrt.2006.094748. Epub 2006 Sep 15.

Dual-loop circuits in postoperative atrial macro re-entrant tachycardias

Jens Seiler  1 , Dorothy K Schmid, Thiemo A Irtel, Hildegard Tanner, Martin Rotter, Nicola Schwick, Etienne Delacrétaz
Affiliations

Dual-loop circuits in postoperative atrial macro re-entrant tachycardias

Jens Seiler et al. Heart. 2007 Mar.

Abstract

Background: Patients may develop dual-loop re-entrant atrial arrhythmias late after open-heart surgery, and mapping and catheter ablation remain challenging despite computer-assisted mapping techniques.

Objectives: The purpose of the study was to demonstrate the prevalence and characteristics of dual-loop re-entrant arrhythmias, and to define the optimal mapping and ablation strategy.

Methods: 40 consecutive patients (mean (SD) age 52 (12) years) with intra-atrial re-entrant tachycardia (IART) after open-heart surgery (with an incision of the right atrial free wall) were studied. Dual-loop IART was defined as the presence of two simultaneous atrial circuits. After an abrupt tachycardia change during radiofrequency ablation, electrical disconnection of the targeted re-entry isthmus from the remaining circuit was demonstrated by entrainment mapping. Furthermore, the second circuit loop was localised using electroanatomical mapping and/or entrainment mapping.

Results: Dual-loop IART was demonstrated in eight (20%, 5 patients with congenital heart disease, 3 with acquired heart disease) patients. Dual-loop IART included an isthmus-dependant atrial flutter combined with a re-entry related to the atriotomy scar. The diagnosis of dual-loop IART required the comparison of entrainment mapping before and after tachycardia modification. Overall, 35 patients had successful radiofrequency ablation (88%). Success rates were lower in patients with dual-loop IART than in patients without dual-loop IART. Ablation failures in three patients with dual-loop IART were related to the inability to properly transect the second tachycardia isthmus in the right atrial free wall.

Conclusions: Dual-loop IART is relatively common after heart surgery involving a right atriotomy. Abrupt tachycardia change and specific entrainment mapping manoeuvres demonstrate these circuits. Electroanatomical mapping appears to be important to assist catheter ablation of periatriotomy circuits.

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Conflict of interest statement

Competing interests: None.

References

    1. Walsh E P. Arrhythmias in patients with congenital heart disease. Card Electrophysiol Rev 20026422–430. - PubMed
    1. Cosio F G, Martin‐Penato A, Pastor A.et al Atypical flutter: a review. Pacing Clin Electrophysiol 2003262157–2169. - PubMed
    1. Saoudi N, Cosio F G, Waldo A.et al Classification of atrial flutter and regular atrial tachycardia according to electrophysiologic mechanism and anatomic bases: a statement from a joint expert group from the Working Group of Arrhythmias of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. J Cardiovasc Electrophysiol 200112852–866. - PubMed
    1. Lesh M D, Kalman J M, Saxon L A.et al Electrophysiology of “incisional” reentrant atrial tachycardia complicating surgery for congenital heart disease. Pacing Clin Electrophysiol 1997202107–2111. - PubMed
    1. Kalman J M, VanHare G F, Olgin J E.et al Ablation of ‘incisional' reentrant atrial tachycardia complicating surgery for congenital heart disease. Use of entrainment to define a critical isthmus of conduction. Circulation 199693502–512. - PubMed

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