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Europace Advance Access originally published online on November 23, 2008
Europace 2009 11(1):48-53; doi:10.1093/europace/eun316
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Ablation: Imaging

Ablation of atrial tachycardias after correction of complex congenital heart diseases: utility of intracardiac echocardiography

Petr Peichl1,*, Josef Kautzner1 and Roman Gebauer2

1 Department of Cardiology, Institute for Clinical and Experimental Medicine, Vídenská 1958/9, 140 21 Prague 4, Czech Republic; 2 Pediatric Heart Center Motol, Prague, Czech Republic

Aims: Our goal was to analyse the utility of intracardiac echocardiography (ICE) for navigation and ablation of atrial tachycardias (ATs) after surgical correction of congenital heart disease (CHD).

Methods and results: Catheter ablation of ATs was performed in seven patients (one woman, mean age 21 ± 6 years) after correction of complex CHD: d-transposition of the great arteries (Mustard procedure in two patients, Senning procedure in two patients) and univentricular circulation (total cavopulmonary connection in two patients, atriopulmonary connection in one patient). The ablation was guided by a combination of electroanatomical mapping (CARTO, Biosense-Webster) and ICE (Acuson, Siemens). Intracardiac echocardiography was used during mapping to identify relevant anatomical structures and monitor tissue contact and for guidance of atrial baffle puncture. Biatrial mapping was necessary in six of seven patients and atrial baffle puncture in three. The clinical AT was abolished in all patients. No complications were noted. During follow-up of 23 ± 13 months, two patients (28%) had arrhythmia recurrence. One patient developed atrial fibrillation, and recurrent AT in the other patient was controlled by re-ablation.

Conclusion: Despite complicated cardiac anatomy, catheter ablation of AT after complex CHD can be performed safely and with a high success rate. Intracardiac echocardiography facilitates mapping, identification of relevant cardiac structures, and could be used for safe guidance of transbaffle puncture.

Key Words: Catheter ablation, Intracardiac ultrasound, Congenital heart diseases

* Corresponding author. Tel: +420 261365021. E-mail address: pepi{at}medicon.cz

Manuscript submitted 21 August 2008. Accepted after revision 27 October 2008.


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