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Europace Advance Access originally published online on January 9, 2006
Europace 2006 8(2):138-139; doi:10.1093/europace/euj032
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

ELECTROPHYSIOLOGY

Mapping and ablation of atypical flutter in congenital heart disease with a novel three-dimensional mapping system (Carto Merge®)

Andreas Pflaumer1,*, Isabel Deisenhofer2, Jörg Hausleiter3 and Bernhard Zrenner2

Department of Paediatric Cardiology and Congenital Heart Disease Deutsches Herzzentrum München, Klinik an der Technischen Universität München, Lazarettstr 36, 80636 München Germany ; Department of Cardiology Deutsches Herzzentrum München, Klinik an der Technischen Universität München, München Germany ; Department of Radiology Deutsches Herzzentrum München, Klinik an der Technischen Universität München, München Germany

Manuscript submitted 22 June 2005. Accepted after revision 27 September 2005.

Corresponding author. Tel: +49 89 1218 2020; fax: +49 89 1218 3013. E-mail address: pflaumer{at}dhm.mhn.de


   Abstract
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 Abstract
 
Mapping and successful ablation of an intra-atrial re-entry tachycardia in a patient after Fontan operation were performed within the anatomy, superimposed from the computed tomography study. In this case, the new system enabled us to display the complex anatomy of the right atrium in detail, whereas the conventional electro-anatomic three-dimensional geometry showed significant inconsistencies.

Key Words: Heart defects, Congenital, Arrhythmia, Catheter ablation, Imaging, Three-dimensional, Tomography, Spiral computed

A 25-year-old patient was admitted for treatment of atrial flutter by electrophysiological (EP) ablation study. His history of congenital heart disease consisted of cardiac dextroversion, atrioventricular discordance, double outlet right ventricle, valvular and subvalvular pulmonary stenosis, and transposition of the great arteries. At the age of 10, he had a Fontan operation, connecting his right atrium to the pulmonary artery (PA), using a graft and closing the pulmonary and tricuspid valve. An EP study using a new three-dimensional (3D) mapping system was performed (Fig. 1). The high-resolution anatomical information from contrast enhanced 64-slice cardiac computed tomography (CT) was reconstructed (Fig. 2). The heart chambers were segmented and implemented in the new electro-anatomic mapping system (Carto Merge®). Mapping and successful ablation of an intra-atrial re-entry tachycardia were performed within the anatomy, superimposed from the CT study. In this case, the new system enabled us to display the complex anatomy of the right atrium in detail, whereas the conventional electro-anatomic 3D geometry showed significant inconsistencies, especially in the region of the anastomosis.


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  		Figure 1 Conventional electro-anatomic map in right anterior oblique (RAO) view. The enlarged right atrium and the graft connecting the atrium with the PA. A clockwise re-entry is located around the atrial base of the graft to the PA. A small scar is part of the central obstacle. The planned ablation line is marked with white dots. The yellow dots mark His signal in the area of the closed tricuspid valve.

 


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  		Figure 2 CT based anatomy (blue) and underlying map (mesh) show the detailed anatomy of the right atrium with coronary sinus, the graft, the PA, and its branches. The importance of the exact anatomical reconstruction can be demonstrated in the area of planned ablation. The conventional anatomic 3D reconstruction is incorrect because of the special anatomical appearance (*) of the anastomosis between the atrium and the PA. With the correct information from the CT, the ablation line (red dots) was placed more lateral and directed to the border of the left PA.

 

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P. Peichl, J. Kautzner, and R. Gebauer
Ablation of atrial tachycardias after correction of complex congenital heart diseases: utility of intracardiac echocardiography
Europace, January 1, 2009; 11(1): 48 - 53.
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