Transbaffle/transconduit puncture using a simple CARTO‐guided approach without echocardiography in patients with congenital heart disease
- 26 May 2020
- journal article
- research article
- Published by Wiley in Journal of Cardiovascular Electrophysiology
- Vol. 31 (8), 2049-2060
- https://doi.org/10.1111/jce.14590
Abstract
Introduction Catheter ablation (CA) of atrial tachyarrhythmias (ATs) in patients with complex congenital heart disease (CHD) often requires technically challenging transbaffle or transconduit puncture. The aim was to assess the feasibility and safety of transbaffle/transconduit puncture based on computed tomography (CT) 3D reconstruction merged with electro‐anatomical mapping (EAM) without per‐procedure echocardiographic guidance. Methods and Results We included 18 consecutive CHD patients in two centers who had atrial‐switch or Fontan surgery and underwent CA of AT by an antegrade approach requiring intracardiac puncture. Twelve patients with atrial‐switch surgery and 6 patients with extracardiac Fontan surgery were referred for CA of atrial tachyarrhythmia. Cardiac CT with 3D reconstruction was performed before the procedure. The 3D volume of the systemic venous atrium or extracardiac conduit acquired by EAM was merged with the corresponding CT 3D reconstruction. The ablation catheter was positioned at the optimal puncture site. Under fluoroscopic guidance, the needle was positioned next to the ablation and the puncture was performed. Balloon expansion of the puncture site was performed in every case of transconduit puncture and in 2 (17%) cases of transbaffle puncture. Overall, 17 intra‐atrial reentrant tachycarrythmias and 9 focal ATs were successfully ablated, with no acute complications. The median time to access the pulmonary atrium was 78.5 min (range 55‐185) and total median fluoroscopy time was 23 min (range 7‐53). Conclusions Transbaffle and transconduit punctures can be performed safely in CHD patients by using a simple technique relying on CT 3D reconstruction and EAM.Keywords
This publication has 21 references indexed in Scilit:
- Acute and Long-Term Outcomes of Catheter Ablation Using Remote Magnetic Navigation in Patients With Congenital Heart DiseaseThe American Journal of Cardiology, 2012
- Catheter Ablation of Atrial Fibrillation in Transposition of the Great Arteries Treated With Mustard Atrial BaffleCirculation: Arrhythmia and Electrophysiology, 2012
- Remote-Controlled Magnetic Navigation and Ablation With 3D Image Integration as an Alternative Approach in Patients With Intra-Atrial Baffle AnatomyCirculation: Arrhythmia and Electrophysiology, 2012
- Outcome of Intra-Atrial Re-Entrant Tachycardia Catheter Ablation in Adults With Congenital Heart Disease: Negative Impact of Age and Complex Atrial SurgeryJournal of Invasive Cardiology, 2010
- Long-Term Outcome After Ablative Therapy of Postoperative Atrial Tachyarrhythmia in Patients With Congenital Heart Disease and Characteristics of Atrial Tachyarrhythmia RecurrencesCirculation: Arrhythmia and Electrophysiology, 2010
- Mortality in adult congenital heart diseaseEuropean Heart Journal, 2010
- Atrial Arrhythmias in Adults With Congenital Heart DiseaseJournal of the American College of Cardiology, 2009
- Implantable Cardioverter-Defibrillators in Tetralogy of FallotJournal of the American College of Cardiology, 2008
- Congenital Heart Disease in the General PopulationJournal of the American College of Cardiology, 2007
- Voltage and Activation MappingJournal of the American College of Cardiology, 2003