Atrial tachycardia eliminated at the ventricular side in patients with congenitally corrected transposition of the great arteries: Electrophysiological findings and anatomical concerns

医学 大动脉 心脏病学 冠状窦 内科学 烧蚀 心动过速 中庭(建筑) 房性心动过速 大血管转位 导管消融 心脏病 心房颤动
作者
Chenxi Jiang,Deyong Long,Xin Du,Caihua Sang,Yan Yao,Mengmeng Li,Ribo Tang,Songnan Li,Songnan Wen,Rong Bai,Jianzeng Dong,Changsheng Ma
出处
期刊:Heart Rhythm [Elsevier]
卷期号:17 (8): 1337-1345 被引量:7
标识
DOI:10.1016/j.hrthm.2020.03.010
摘要

Background The unique malformation of congenitally corrected transposition of the great arteries (cc-TGA) makes the pulmonary outflow tract (POT) a possible origin of atrial tachycardia (AT). Objective The purpose of this study was to investigate the mapping characteristics of ATs successfully ablated at the POT in patients with cc-TGA. Methods Patients with cc-TGA with AT eliminated at the POT were analyzed. Activation mapping of the atria and POT was performed under the guidance of a 3-dimensional electroanatomic mapping system. The activation pattern of these chambers was investigated, with the local activation time (LAT; using coronary sinus ostium as a reference) of the earliest activation site (EAS) being compared. Results AT eliminated at the POT was documented in 5 of 6 patients with cc-TGA. The EAS was at the right anteroseptal region with a LAT of 33 (21–120) ms in the right atrium and at the septal wall with a comparable LAT (26, 47, and 26 ms; P = .604) in the left atrium. The EAS of the POT was in the vicinity of the left-facing pulmonary sinus cusp in 3 cases and the nonfacing pulmonary sinus cusp in 2 cases, with a LAT of 106 (28–134) ms preceding both atria. Ablation at this site successfully eliminated AT in all 5 cases. Conclusion AT arising adjacent to the POT is not an uncommon tachycardia in patients with situs solitus–type cc-TGA and can be safely eliminated by ablation targeting the EAS in the POT. The unique malformation of congenitally corrected transposition of the great arteries (cc-TGA) makes the pulmonary outflow tract (POT) a possible origin of atrial tachycardia (AT). The purpose of this study was to investigate the mapping characteristics of ATs successfully ablated at the POT in patients with cc-TGA. Patients with cc-TGA with AT eliminated at the POT were analyzed. Activation mapping of the atria and POT was performed under the guidance of a 3-dimensional electroanatomic mapping system. The activation pattern of these chambers was investigated, with the local activation time (LAT; using coronary sinus ostium as a reference) of the earliest activation site (EAS) being compared. AT eliminated at the POT was documented in 5 of 6 patients with cc-TGA. The EAS was at the right anteroseptal region with a LAT of 33 (21–120) ms in the right atrium and at the septal wall with a comparable LAT (26, 47, and 26 ms; P = .604) in the left atrium. The EAS of the POT was in the vicinity of the left-facing pulmonary sinus cusp in 3 cases and the nonfacing pulmonary sinus cusp in 2 cases, with a LAT of 106 (28–134) ms preceding both atria. Ablation at this site successfully eliminated AT in all 5 cases. AT arising adjacent to the POT is not an uncommon tachycardia in patients with situs solitus–type cc-TGA and can be safely eliminated by ablation targeting the EAS in the POT.
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