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Atrial flutter catheter ablation in adult patients with repaired tetralogy of Fallot: mechanisms and outcomes of percutaneous catheter ablation in a consecutive series

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Abstract

Background

Prior investigators note successful ablation of both typical cavotricuspid isthmus-dependent and scar-related macroreentrant right atrial flutters (AFL) in adult patients with repaired tetralogy of Fallot (TOF). However, an analysis of the mechanisms (including a description of a uniform approach to diagnose such mechanisms), and clinical outcomes of catheter ablation in a consecutive series of adult patients with AFL late after surgical TOF repair has not been previously reported.

Methods

Background clinical data and follow-up were evaluated in a consecutive series of TOF patients evaluated from September 2001 to June 2008.

Results

We report a prevalence of sustained, symptomatic AFL in patients with repaired TOF equal to 20% (28/140 patients), and of recurrent, drug-refractory and/or severely symptomatic AFL to be 11% (16/140 patients). The AFLs manifested variable cycle lengths ranging from 215 to 525 ms. Underlying mechanisms were: (1) cavotricuspid (CTI)-dependent, counterclockwise atrial flutter (n = 8 patients); (2) non-CTI-dependent macroreentrant scar-related AFL (n = 6 patients); and (3) both CTI- and non-CTI-dependent macroreentrant AFL (n = 2 patients). Recurrent arrhythmias occurred in six patients, five of whom were successfully treated with repeat ablation. After a mean follow-up of 23 months, 15 of 16 patients were alive and free of sustained AFL.

Conclusions

AFL late after surgical TOF repair occurs in 20% of such patients. In more than half of these patients, the AFLs are drug-refractory and/or severely symptomatic. Despite the presence of congenital heart disease treated with prior cardiac surgery and AFLs with variable atrial cycle lengths, the CTI-dependent mechanism underlies approximately half of the sustained, symptomatic AFLs.

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Abbreviations

AFL:

Atrial flutter

RA:

Right atrium

EP:

Electrophysiological

CTI:

Cavotricuspid isthmus

TOF:

Tetralogy of Fallot

RFA:

Radiofrequency ablation

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Acknowledgments

The authors would like to thank Ms. Cecille Garcia, N.P., for her assistance with data collection and Ms. AnnaMaria Arias for assistance with manuscript preparation.

Funding Sources

Funded in part by a grant from the New York State Empire Clinical Research Investigator Program (Dr. Biviano).

Disclosures

The authors report no conflicts related to this article.

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Authors and Affiliations

  1. Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, NY, USA

    Angelo Biviano, Hasan Garan, Kathleen Hickey, William Whang, Jose Dizon & Marlon Rosenbaum

  2. Columbia University Medical Center, 177 Fort Washington Avenue, Milstein 5-435F, New York, NY, 10032, USA

    Angelo Biviano

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  1. Angelo Biviano
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  2. Hasan Garan
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Correspondence to Angelo Biviano.

Additional information

Biviano, atrial flutter in tetralogy of Fallot, and catheter ablation outcomes

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Biviano, A., Garan, H., Hickey, K. et al. Atrial flutter catheter ablation in adult patients with repaired tetralogy of Fallot: mechanisms and outcomes of percutaneous catheter ablation in a consecutive series. J Interv Card Electrophysiol 28, 125–135 (2010). https://doi.org/10.1007/s10840-010-9477-5

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  • DOI: https://doi.org/10.1007/s10840-010-9477-5

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