Late Atrial Tachyarrhythmias After Repair of Congenital Heart Disease What is the Mechanism and How Can They Be Localized and Ablated?

  • R. Mantovan
Conference paper


Supraventricular arrhythmias are often seen in patients who have undergone corrective surgery for congenital heart disease, and they are associated with elevated morbidity. Although atrial fibrillation is a common finding in such patients, many supraventricular arrhythmias take the form of reentrant atrial tachycardia and/or flutter [1–4]. Several recent papers have focused on the mechanisms and the characteristics of these arrhythmias. Because of the clear relationship between atrial reentrant tachycardias and the presence of scars or prosthetic materials they are called ‘incisional’ atrial tachycardias [5–13]. These arrhythmias can occur more frequently after correction of atrial septal defect, tetralogy of Fallot, Mustard and Senning or Fontan procedures [1–4].


Congenital Heart Disease Atrial Septal Defect Atrial Tachycardia Reentrant Tachycardia Atrial Septal Defect Closure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Mantovan R, Gatzoulis MA, Pedrocco A et al (2003) Supraventricular arrhythmia before and after surgical closure of atrial septal defects: spectrum, prognosis and management. Europace 5:133–138PubMedCrossRefGoogle Scholar
  2. 2.
    Van Hare GF, Lesh MD, Ross BA, Perry JC, Dorostkar PC (1996) Mapping and radiofrequency ablation of intraatrial reentrant tachycardia after the Senning or Mustard procedure for transposition of the great arteries. Am J Cardiol 77:985–991PubMedCrossRefGoogle Scholar
  3. 3.
    Kirsh JA, Walsh EP, Triedman JK (2002) Prevalence of and risk factors for atrial fibrillation and intra-atrial reentrant tachycardia among patients with congenital heart disease. Am J Cardiol 90:338–340PubMedCrossRefGoogle Scholar
  4. 4.
    Durongpisitkul K, Porter CJ, Cetta F et al (1998) Predictors of early-and late-onset supraventricular tachyarrhythmias after Fontan operation. Circulation 98:1099–1107PubMedCrossRefGoogle Scholar
  5. 5.
    Triedman JK, Saul P, Weindling SN et al (1995) Radiofrequency ablation of intra-atrial reentrant tachycardia after surgical palliation of congenital heart disease. Circulation 91:707–714PubMedCrossRefGoogle Scholar
  6. 6.
    Baker BM, Lindsay BD, Bromberg B et al (1996) Catheter ablation of intra-atrial reentrant tachycardias resulting from previous atrial surgery: locating and transecting the critical isthmus. J Am Coll Cardiol 28:411–417PubMedGoogle Scholar
  7. 7.
    Kaiman JM, VanHare GF, Olgin JE et al (1996) Ablation of “incisional” re-entrant atrial tachycardia complicating surgery for congenital heart disease: use of entrain-ment to define a critical isthmus of conduction. Circulation 93:502–512CrossRefGoogle Scholar
  8. 8.
    Collins KK, Love BA, Walsh EP et al (2000) Location of acutely successful radiofrequency catheter ablation of intra-atrial re-entrant tachycardia in patients with congenital heart disease. Am J Cardiol 86:969–974PubMedCrossRefGoogle Scholar
  9. 9.
    Triedman JK, Bergau DM, Saul JP, Epstein MR, Walsh EP (1997) Efficacy of radiofrequency ablation for control of intra-atrial re-entrant tachycardia in patients with congenital heart disease. J Am Coll Cardiol 30:1032–1038PubMedCrossRefGoogle Scholar
  10. 10.
    Dorostkar PC, Cheng J, Scheinman MM (1998) Electroanatomical mapping and ablation of the substrate supporting intra-atrial re-entrant tachycardia after palliation for complex congenital heart disease. Pacing Clin Electrophysiol 21:1810–1819PubMedCrossRefGoogle Scholar
  11. 11.
    Love BA, Collins KK, Walsh EP, Triedman JK (2001 ) Electroanatomic characterization of conduction barriers in sinus/atrially paced rhythm and association with intraatrial re-entrant tachycardia circuits following congenital heart disease surgery. J Cardiovasc Electrophysiol 12:17–25PubMedCrossRefGoogle Scholar
  12. 12.
    Nakagawa H, Shah N, Matsudaira K et al (2001) Characterization of reentrant circuit in macroreentrant right atrial tachycardia after surgical repair of congenital heart disease: isolated channels between scars allow “focal” ablation. Circulation 103:699–709PubMedCrossRefGoogle Scholar
  13. 13.
    Anne W, van Rensburg H, Adams J et al (2002) Ablation of post-surgical intra-atrial reentrant tachycardia. Predilection target sites and mapping approach. Eur Heart J 23:1609–1616PubMedCrossRefGoogle Scholar
  14. 14.
    Mines G (1913) On dynamic equilibrium in the heart. J Physiol 46:349–383PubMedGoogle Scholar
  15. 15.
    Olgin JE, Kaiman JM, Lesh MD (1996) Conduction barriers in human atrial flutter: correlation of electrophysiology and anatomy. J Cardiovasc Electrophysiol 7:1112–1126PubMedCrossRefGoogle Scholar
  16. 16.
    Frame LH, Page RL, Boyden PA, Fenoglio JJ Jr, Hoffman BF (1987) Circus movement in the canine atrium around the tricuspid ring during experimental atrial flutter and during reentry in vitro. Circulation 76:1155–1175PubMedCrossRefGoogle Scholar
  17. 17.
    Shah D, Jais P, Takahashi A et al (2000) Dual-loop intra-atrial reentry in humans. Circulation 101:631–639PubMedCrossRefGoogle Scholar
  18. 18.
    Ben-Haim SA, Osadchy D, Schuster I et al (1996) Nonfluoroscopic, in vivo navigation and mapping technology. Nat Med 2:1393–1395PubMedCrossRefGoogle Scholar
  19. 19.
    Molenschot M, Ramanna H, Hoorntje T et al (2001) Catheter ablation of incisional atrial tachycardia using a novel mapping system: LocaLisa. Pacing Clin Electrophysiol 24:1616–1622PubMedCrossRefGoogle Scholar
  20. 20.
    Triedman JK, Alexander ME, Love BA et al (2002) Influence of patient factors and ablative technologies on outcomes of radiofrequency ablation of intra-atrial reentrant tachycardia in patients with congenital heart disease. J Am Coll Cardiol 39:1827–1835PubMedCrossRefGoogle Scholar
  21. 21.
    Blaufox AD, Numan MT, Laohakunakorn P et al (2002) Catheter tip cooling during radiofrequency ablation of intra-atrial reentry: effects on power, temperature, and impedance. J Cardiovasc Electrophysiol 13:783–787PubMedCrossRefGoogle Scholar
  22. 22.
    Ebels T (1997) Can intraatrial reentry be prevented by changes in surgical technique? Pacing Clin Electrophysiol 20 [Pt II]:2118–2120PubMedCrossRefGoogle Scholar
  23. 23.
    Gandhi SK, Bromberg BI, Rodefeld MD et al (1996) Lateral tunnel suture line variation reduces atrial flutter after the modified Fontan operation. Ann Thorac Surg 61:1299–1309PubMedCrossRefGoogle Scholar
  24. 24.
    Ebels T, Elzenga NJ, Brenken U (1992) Right atrial auricle as inter-caval tunnel in the cavopulmonary connexion: method to avoid the sinus node and its blood supply. In: Minami K, Körfer R, Wada J (eds) Cardiothoracic surgery. What’s new in current practice. Elsevier-Excerpta Medica, Amsterdam, pp 9–16Google Scholar
  25. 25.
    Bink-Boelkens MTE, Meuzelaar KS, Eygelaar A (1988) Arrhythmias after repair of secundum atrial septal defect: the influence of surgical modification. Am Heart J 115:629–633CrossRefGoogle Scholar
  26. 26.
    Mantovan R, Pedrocco A, Buià G et al (2002) Radiofrequency ablation during atrial septal defect repair surgery: a new treatment of atrial fibrillation (abstract). Europace 3 [Suppl] abs 238Google Scholar

Copyright information

© Springer-Verlag Italia 2004

Authors and Affiliations

  • R. Mantovan
    • 1
  1. 1.Divisione di CardiologiaOspedale Regionale“Ca’ Foncello”TrevisoItaly

Personalised recommendations