Catheter ablation of tachycardia arising from the pulmonary venous atrium after surgical repair of congenital heartdisease.

Heart Rhythm. 2015 Feb;12(2):297-304. doi: 10.1016/j.hrthm.2014.11.038. Epub 2014 Nov 28.

Catheter ablation of tachycardia arising from the pulmonary venous atrium after surgical repair of congenital heartdisease.

Moore JP1Russell M2Mandapati R3Aboulhosn JA4Shannon KM5.

Comment: The majority of atrial arrhythmias and interventions in the adult congenital heart disease population involve the systemic venous atrium (SVA) because of the extent of surgical incisions, suture lines, and patch material in and around this chamber.  Less is known about the mechanism and treatment of arrhythmias arising from the pulmonary venous atrium (PVA).  Moore and colleagues investigated ablations performed on patients with d-TGA s/p Mustard or Senning, univentricular hearts s/p Fontan (AP, Bjork, ECT, LT), and biventricular hearts with repaired CHD.  19% of tachycardias induced in these patients over a four year period mapped to the PVA.  This was more frequent in patients with a history of incision in this atrium and less frequent in biventricular patients.  Intra-atrial re-entrant tachycardia was observed in 47% of PVA tachycardia (compared to 73% in SVA).  In patients with biventricular repair, LA nonautomatic focal tachycardias were the most common.  In univentricular hearts, the most common tachycardias in the PVA were AVNRT and AVRT mediated by twin AV nodes.  In patients with d-TGA baffles, the most common PVA mechanism was IART, most of which were CTI-dependent.  Success was achieved in 80% of procedures and 83% of tachycardias.  Complications included fluid overload in one patient and transient SND in 2 patients.  The recurrence rate was 16% in 3.2 months (0.9-11.9).  PVA tachycardias were more likely to recur than SVA tachycardias.  This study adds to our understanding of mechanisms and effectiveness of catheter ablations on PVA tachycardias in adults with congenital heart disease.