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Ablation of atrial tachyarrhythmias late after surgical repair of tetralogy of Fallot

Lookup NU author(s): Dr Daniel Raine, Dr John O'Sullivan, Dr John Bourke


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Background: Patients with repaired tetralogy of Fallot may develop symptomatic and haemodynamic deterioration for many reasons such as arrhythmia, pulmonary regurgitation, and impairment in ventricular function. We describe a consecutive group of patients whose main clinical problem was atrial tachyarrhythmias. Aims: To describe the clinical outcome of atrial tachyarrhythmias occurring late after surgical repair of tetralogy of Fallot; to define the circuits/foci responsible for these atrial tachyarrhythmias; to evaluate the outcome of computer-assisted mapping and catheter ablation in this patient group. Methods and results: Consecutive patients with surgically repaired tetralogy of Fallot and atrial tachyarrhythmias, who underwent catheter ablation between January, 2001 and June, 2007, were identified retrospectively from case records. Computer-assisted mapping was performed in all using either EnSite (R) (St Jude Medical Inc.) arrhythmia mapping and intra-cardiac catheter guidance system or CARTO (TM) (Biosense Webster Inc.) electroanatomical mapping systems. Ten patients (four males) with a median age of 39 plus or minus 8 years were studied. The total number of atrial tachyarrhythmias identified was 22 (six macro-reentrant, 16 micro-reentrant/focal). In nine patients, catheter ablation led to improvement in arrhythmia episodes and/or symptoms during follow-up of 41 plus or minus 20 months. Following ablation(s), five patients required pacing for pre-existing conduction disease and five needed further surgery for haemodynamic indications. All patients remained on anti-arrhythmic drugs. Conclusions: Patients with surgically repaired tetralogy of Fallot and atrial tachyarrhythmias typically have multiple arrhythmic circuits/foci arising from a scarred right atrium. Catheter ablation reduces arrhythmia frequency and improves symptoms. However, hybrid management is often required, comprising drugs, pacing, and further surgery tailored to the individual.

Publication metadata

Author(s): O'Sullivan J; Bourke JP; Raine D; Chaudhari M; Hamilton L; Hasan A

Publication type: Article

Publication status: Published

Journal: Cardiology in the Young

Year: 2011

Volume: 21

Issue: 1

Pages: 31-38

Print publication date: 27/10/2010

ISSN (print): 1047-9511

ISSN (electronic): 1467-1107

Publisher: Cambridge University Press


DOI: 10.1017/S1047951110001447


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