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J Am Coll Cardiol, 2000; 35:428-441
© 2000 by the American College of Cardiology Foundation
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CLINICAL STUDIES

Radiofrequency catheter ablation of supraventricular tachycardia substrates after mustard and senning operations for d-transposition of the great arteries

Ronald J. Kanter, MD, FACC*, John Papagiannis, MD§, Michael P. Carboni, MD*, Ross M. Ungerleider, MD, FACC{dagger}, William E. Sanders, MD, FACC|| and J. Marcus Wharton, MD, FACC{ddagger}

* Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
{dagger} Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
{ddagger} Department of Internal Medicine, Duke University School of Medicine, Durham, North Carolina, USA
§ Department of Pediatric Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
|| Department of Internal Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA

Manuscript received November 17, 1998; revised manuscript received September 3, 1999, accepted October 18, 1999.

Reprint requests and correspondence: Dr. Ronald J. Kanter, Duke University Medical Center, Box 3090, Durham, NC 27710
kante001{at}mc.duke.edu

OBJECTIVES

The purpose of this study was to determine the efficacy and risks of radiofrequency ablation of various forms of supraventricular tachycardia after Mustard and Senning operations for d-transposition of the great arteries.

BACKGROUND

In this patient group, the reported success rate of catheter ablation of intraatrial reentry tachycardia is about 70% with a negligible complication rate. There are no reports of the use of radiofrequency ablation to treat other types of supraventricular tachycardia.

METHODS

Standard diagnostic criteria were used to determine supraventricular tachycardia type. Appropriate sites for attempted ablation included 1) intraatrial reentry tachycardia: presence of concealed entrainment with a postpacing interval similar to tachycardia cycle length; 2) focal atrial tachycardia: a P-A interval ≤–20 ms; and 3) typical variety of atrioventricular (AV) node reentry tachycardia: combined electrographic and radiographic features.

RESULTS

Nine Mustard and two Senning patients underwent 13 studies to successfully ablate all supraventricular tachycardia substrates in eight (73%) patients. Eight of eleven (73%) patients having intraatrial reentry tachycardia, 3/3 having typical AV node reentry tachycardia, and 2/2 having focal atrial reentry tachycardia were successfully ablated. Among five patients having intraatrial reentry tachycardia (IART) and not having ventriculoatrial (V-A) conduction, two suffered high-grade AV block when ablation of the systemic venous portion of the medial tricuspid valve/inferior vena cava isthmus was attempted.

CONCLUSIONS

Radiofrequency catheter ablation can be effectively and safely performed for certain supraventricular tachycardia types in addition to intraatrial reentry. A novel catheter course is required for slow pathway modification. High-grade AV block is a potential risk of lesions placed in the systemic venous medial isthmus.

Abbreviations and Acronyms
  AV = atrioventricular
  FAT = focal atrial tachycardia
  IART = intraatrial reentry tachycardia
  V-A = ventriculoatrial




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