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Left-sided ablation of ventricular tachycardia in adults with repaired tetralogy of Fallot: a case series.
- Source :
-
Circulation. Arrhythmia and electrophysiology [Circ Arrhythm Electrophysiol] 2014 Oct; Vol. 7 (5), pp. 889-97. Date of Electronic Publication: 2014 Aug 23. - Publication Year :
- 2014
-
Abstract
- Background: Radiofrequency catheter ablation (RFCA) of ventricular tachycardia (VT) in repaired Tetralogy of Fallot focuses on isthmuses in the right ventricle but may be hampered by hypertrophied myocardium or prosthetic material. These patients may benefit from ablation at the left side of the ventricular septum.<br />Methods and Results: Records from 28 consecutive repaired Tetralogy of Fallot patients from 2 centers who underwent VT ablation were reviewed. Ablation targeted anatomic isthmuses containing VT re-entry circuits, which were identified by 3-dimensional substrate, pace, and entrainment mapping. A left-sided approach was considered beneficial if (1) right-sided RFCA failed, (2) part of the circuit was mapped to the left side, and (3) left-sided RFCA resulted in isthmus transection and prevention of VT induction. In 4 of 28 patients (52±13 years; 75% men), inducible for 1.5 (quartiles, 1.0 - 2.0) VTs (335±58 ms), left-sided RFCA was performed. In 3 patients, RFCA at aortic sites terminated VT related to a septal isthmus and prevented reinduction. In 1 patient, with prior biventricular implantable cardioverter-defibrillator, diastolic activity was recorded at the left side of the septum in proximity to the His-bundle. RFCA prevented VT reinduction with anticipated complete atrioventricular block. The left-sided approach resulted in complete procedural success (transection of anatomic isthmus and noninducibility) and freedom of VT recurrence during follow-up (20±15 months) in all patients. Right-sided RFCA failure was likely because of septal hypertrophy in 2, overlying pulmonary homograft in 1, and overlying ventricular septal defect patch in 1.<br />Conclusions: Left-sided RFCA for VTs dependent on septal anatomic isthmuses improves ablation outcome in repaired Tetralogy of Fallot.<br /> (© 2014 American Heart Association, Inc.)
- Subjects :
- Action Potentials
Adult
Aged
Cardiac Pacing, Artificial
Catheter Ablation adverse effects
Electrocardiography
Electrophysiologic Techniques, Cardiac
Female
Heart Ventricles physiopathology
Humans
Male
Middle Aged
Netherlands
Predictive Value of Tests
Reoperation
Risk Factors
Tachycardia, Ventricular diagnosis
Tachycardia, Ventricular etiology
Tachycardia, Ventricular physiopathology
Tetralogy of Fallot complications
Treatment Outcome
Ventricular Function, Left
Ventricular Function, Right
Cardiac Surgical Procedures adverse effects
Catheter Ablation methods
Heart Ventricles surgery
Tachycardia, Ventricular surgery
Tetralogy of Fallot surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1941-3084
- Volume :
- 7
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Circulation. Arrhythmia and electrophysiology
- Publication Type :
- Academic Journal
- Accession number :
- 25151630
- Full Text :
- https://doi.org/10.1161/CIRCEP.114.001661