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Lateral tunnel Fontan atrial tachycardia ablation trans-baffle access is not mandatory as the initial strategy

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Abstract

Background

Mapping and ablation of atrial tachycardia (AT) is commonly performed in lateral tunnel Fontan (LTF) patients, yet there is little information on the need of baffle puncture to access the pulmonary venous atrium (PVA). This study aimed to evaluate the most common chamber location of critical sites for majority of AT in LTF patients.

Methods

Consecutive LTF patients underwent catheter-based high-density mapping and ablation of AT from Nov. 2015 to Mar. 2019. Critical sites were identified by a combination of activation and entrainment mapping. Acute procedural success was defined as AT termination with ablation and non-inducibility of any AT. Predictors for ablation failure were evaluated in retrospect.

Results

Fifteen catheter ablation procedures were performed in 9 patients. A total of 15 clinical ATs (mean TCL 369 ± 91 ms) were mapped. The mechanism was macro re-entry in 11 (73%) and micro re-entry in 2. In 11 ATs (73%), 94 ± 5% of tachycardia cycle length (TCL) were mapped inside the tunnel. The commonest site of successful ablation in the tunnel was on the lateral wall (60%). Trans-baffle access was obtained during 5 of 15 procedures (33%). Overall, procedural success was achieved in 9 of 15 procedures (60%). There were no complications. Recurrence of AT was 42% over a follow-up period of 4.3 ± 3.2 years. Faster TCL of 200–300 ms showed a trend towards ablation failure, (OR 17, 95% CI 0.7 to 423, p = 0.08).

Conclusions

Catheter ablation can be performed effectively for ATs in LTF patients usually from inside the tunnel. ATs with critical sites in the PVA are uncommon. This information will help plan ablation in LTF patients without resorting to initial trans-baffle access.

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Acknowledgements

Dr. Erwin Oechslin currently holds the Bitove Family Professorship of Adult Congenital Heart Disease.

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Authors and Affiliations

  1. Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada

    Abhishek Bhaskaran, Sachin Nayyar, Pradeepkumar Charla, Yawer Saeed, Shouvik Haldar, Andreu Porta-Sánchez, Priyanka Kugamoorthy, Christian Jons, Erwin Oechslin, Edward Hickey, Louise Harris, Candice Silversides, S. Lucy Roche, Eugene Downar, Kumaraswamy Nanthakumar & Krishnakumar Nair

  2. Biosense Webster, Irvine, USA

    Amanvir Hans

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  1. Abhishek Bhaskaran
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Correspondence to Krishnakumar Nair.

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Ethics approval was obtained from the University Health Network research review board.

Conflict of interest

Amanvir Hans is a Biosense Webster employee. Dr. Nanthakumar is a consultant for Biosense Webster. Dr Porta-Sánchez is a consultant for Abbot Medical.

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Bhaskaran, A., Nayyar, S., Charla, P. et al. Lateral tunnel Fontan atrial tachycardia ablation trans-baffle access is not mandatory as the initial strategy. J Interv Card Electrophysiol 58, 299–306 (2020). https://doi.org/10.1007/s10840-019-00580-5

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  • DOI: https://doi.org/10.1007/s10840-019-00580-5

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