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CLINICAL STUDY

Coexistence of type I atrial flutter and intra-atrial re-entrant tachycardia in patients with surgically corrected congenital heart disease

^a Cardiovascular Division, Department of Internal Medicine, University of Virginia Hospital, Charlottesville, Virginia, USA

Manuscript received September 11, 2000; revised manuscript received April 10, 2001, accepted April 23, 2001.

Reprint requests and correspondence: Dr. J. Paul Mounsey, P.O. Box 800158, University of Virginia Health System, Charlottesville, Virginia 22908
pmounsey{at}virginia.edu

OBJECTIVES

This study assessed the coexistence of intra-atrial re-entrant tachycardia (IART) and isthmus-dependent atrial flutter (IDAF) in patients presenting with supraventricular tachyarrhythmias after surgical correction of congenital heart disease (CHD).

BACKGROUND

In patients with CHD, atrial tachyarrhythmias may result from IART or IDAF. The frequency with which IART and IDAF coexist is not well defined.

METHODS

Both IDAF and IART were diagnosed in 16 consecutive patients using standard criteria and entrainment mapping. Seven patients had classic atrial flutter morphology on surface electrocardiogram (ECG), whereas nine had atypical morphology.

RESULTS

A total of 24 circuits were identified. Three patients had IDAF only, five had IART only, seven had both, and one had a low right atrial wall tachycardia that could not be entrained. Twenty-two different reentry circuits were ablated. Successful ablation was accomplished in 13 of 14 (93%) IART and 9 of 10 (90%) IDAF circuits. There was one IART recurrence. The slow conduction zone involved the region of the right atriotomy scar in 12 of 14 (86%) IART circuits. No procedural complications and no further recurrences were seen after a mean follow-up of 24 months.

CONCLUSIONS

Both IDAF and IART are the most common mechanisms of atrial re-entrant tachyarrhythmias in patients with surgically corrected CHD, and they frequently coexist. The surface ECG is a poor tool for identifying patients with coexistent arrhythmias. The majority of IART circuits involve the lateral right atrium and may be successfully ablated by creating a lesion extending to the inferior vena cava.

Abbreviations and Acronyms   AF = atrial flutter   ASD = atrial septal defect   AV = atrioventricular   CHD = congenital heart disease   ECG = electrocardiogram   EP = electrophysiologic   IART = intra-atrial re-entrant tachycardia   IDAF = isthmus-dependent atrial flutter   IVC = inferior vena cava, inferior vena caval   NYHA = New York Heart Association   RF = radiofrequency   ToF = tetralogy of Fallot   VSD = ventricular septal defect

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