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

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Bhaskaran, A, Nayyar, S, Charla, P, Saeed, Y, Haldar, S, Porta-Sánchez, A, Kugamoorthy, P, Hans, A, Jons, C, Oechslin, E, Hickey, E, Harris, L, Silversides, C, Roche, SL, Downar, E, Nanthakumar, K & Nair, K 2020, 'Lateral tunnel Fontan atrial tachycardia ablation trans-baffle access is not mandatory as the initial strategy', Journal of Interventional Cardiac Electrophysiology, vol. 58, no. 3, pp. 299-306. https://doi.org/10.1007/s10840-019-00580-5

APA

Bhaskaran, A., Nayyar, S., Charla, P., Saeed, Y., Haldar, S., Porta-Sánchez, A., Kugamoorthy, P., Hans, A., Jons, C., Oechslin, E., Hickey, E., Harris, L., Silversides, C., Roche, S. L., Downar, E., Nanthakumar, K., & Nair, K. (2020). Lateral tunnel Fontan atrial tachycardia ablation trans-baffle access is not mandatory as the initial strategy. Journal of Interventional Cardiac Electrophysiology, 58(3), 299-306. https://doi.org/10.1007/s10840-019-00580-5

CBE

Bhaskaran A, Nayyar S, Charla P, Saeed Y, Haldar S, Porta-Sánchez A, Kugamoorthy P, Hans A, Jons C, Oechslin E, Hickey E, Harris L, Silversides C, Roche SL, Downar E, Nanthakumar K, Nair K. 2020. Lateral tunnel Fontan atrial tachycardia ablation trans-baffle access is not mandatory as the initial strategy. Journal of Interventional Cardiac Electrophysiology. 58(3):299-306. https://doi.org/10.1007/s10840-019-00580-5

MLA

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Author

Bhaskaran, Abhishek ; Nayyar, Sachin ; Charla, Pradeepkumar ; Saeed, Yawer ; Haldar, Shouvik ; Porta-Sánchez, Andreu ; Kugamoorthy, Priyanka ; Hans, Amanvir ; Jons, Christian ; Oechslin, Erwin ; Hickey, Edward ; Harris, Louise ; Silversides, Candice ; Roche, S Lucy ; Downar, Eugene ; Nanthakumar, Kumaraswamy ; Nair, Krishnakumar. / Lateral tunnel Fontan atrial tachycardia ablation trans-baffle access is not mandatory as the initial strategy. In: Journal of Interventional Cardiac Electrophysiology. 2020 ; Vol. 58, No. 3. pp. 299-306.

Bibtex

@article{b6291202780841639b2968aaf3a0fed8,
title = "Lateral tunnel Fontan atrial tachycardia ablation trans-baffle access is not mandatory as the initial strategy",
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.",
keywords = "Adult congenital arrhythmia, Atrial flutter mapping, Atrial tachycardia, Electro-anatomical mapping, Intra-atrial re-entrant tachycardia, Lateral tunnel Fontan",
author = "Abhishek Bhaskaran and Sachin Nayyar and Pradeepkumar Charla and Yawer Saeed and Shouvik Haldar and Andreu Porta-S{\'a}nchez and Priyanka Kugamoorthy and Amanvir Hans and Christian Jons and Erwin Oechslin and Edward Hickey and Louise Harris and Candice Silversides and Roche, {S Lucy} and Eugene Downar and Kumaraswamy Nanthakumar and Krishnakumar Nair",
year = "2020",
month = sep,
doi = "10.1007/s10840-019-00580-5",
language = "English",
volume = "58",
pages = "299--306",
journal = "Journal of Interventional Cardiac Electrophysiology",
issn = "1383-875X",
publisher = "Springer New York LLC",
number = "3",

}

RIS

TY - JOUR

T1 - Lateral tunnel Fontan atrial tachycardia ablation trans-baffle access is not mandatory as the initial strategy

AU - Bhaskaran, Abhishek

AU - Nayyar, Sachin

AU - Charla, Pradeepkumar

AU - Saeed, Yawer

AU - Haldar, Shouvik

AU - Porta-Sánchez, Andreu

AU - Kugamoorthy, Priyanka

AU - Hans, Amanvir

AU - Jons, Christian

AU - Oechslin, Erwin

AU - Hickey, Edward

AU - Harris, Louise

AU - Silversides, Candice

AU - Roche, S Lucy

AU - Downar, Eugene

AU - Nanthakumar, Kumaraswamy

AU - Nair, Krishnakumar

PY - 2020/9

Y1 - 2020/9

N2 - 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.

AB - 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.

KW - Adult congenital arrhythmia

KW - Atrial flutter mapping

KW - Atrial tachycardia

KW - Electro-anatomical mapping

KW - Intra-atrial re-entrant tachycardia

KW - Lateral tunnel Fontan

U2 - 10.1007/s10840-019-00580-5

DO - 10.1007/s10840-019-00580-5

M3 - Journal article

C2 - 31399922

VL - 58

SP - 299

EP - 306

JO - Journal of Interventional Cardiac Electrophysiology

JF - Journal of Interventional Cardiac Electrophysiology

SN - 1383-875X

IS - 3

ER -

ID: 59120938