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Atrial flutter ablation in congenital heart disease
Session:
Posters (Sessão 1 - Écran 4) - Cardiopatias congénitas
Speaker:
Catarina Oliveira
Congress:
CPC 2023
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
20. Congenital Heart Disease and Pediatric Cardiology
Subtheme:
20.6 Congenital Heart Disease – Clinical
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Catarina Simões De Oliveira; Joana Brito; Pedro Alves da Silva; Beatriz Valente Silva; Beatriz Garcia; Ana Margarida Martins; Miguel Raposo; João Ribeiro; Afonso Nunes Ferreira; Gustavo Lima Silva; Luis Carpinteiro; Nuno Cortez-Dias; Fausto J. Pinto; João de Sousa
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction: </strong>Atrial flutter (Afl) is a common cause of decompensation in patients (pts) with congenital heart disease (CHD), particularly in the ones with complex anomalies. Catheter ablation is an attractive treatment option in these pts.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose: </strong>Characterization of the AFl mechanism in context of CHD.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods: </strong>Retrospective single-center study of consecutive pts with CHD submitted to AFl ablation between 2015 and 2022. Electroanatomical high-density voltage and activation maps were collected with multipolar catheters using Carto, Ensite or Rhythmia mapping systems. Acute success was defined as conversion to sinus rhythm after the critical isthmus ablation.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results: </strong>Eight patients with CHD were treated. The CHD complexity was severe, moderate and mild in 1, 5 and 2, respectively. All AFl presented macro reentrant mechanism. The circuit was right-sided in 7/8, presenting a peri-tricuspid rotation in 5 pts (counterclockwise in 3 and clockwise in 2). Of note, 1 of them presented a complex 3-loop circuit with rotations around an incisional lateral wall scar, tricuspid annulus and inferior vena cava. In 2 pts, a non-cavotricuspid isthmus (CTI) dependent single loop mechanism was recognized, involving a slow-conduction isthmus at an incisional lateral wall scar. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Regarding the patient with left AFl, the macro-reentry was dual-loop with a counterclockwise perimitral rotation and a loop around the right pulmonary veins. This was the only pt that converted into a 2<sup>nd</sup> AFl, which presented a right-sided dual loop mechanism, with a rotation around a pericardial patch and a clockwise CTI loop. The critical isthmus ablation resulted in acute success in all pts, who remained free from recurrences during follow-up.</span></span></p> <p><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Conclusion: </span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">AFl ablation is an effective strategy in pts with CHD.</span></span></p>
Slides
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