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Importance of Tachycardia Cycle Length for Differentiating Typical Atrial Flutter from Scar‐Related in Adult Congenital Heart Disease
Author(s) -
UHM JAESUN,
MUN HEESUN,
WI JIN,
SHIM JAEMIN,
HWANG HYE JIN,
SUNG JUNGHOON,
KIM JONGYOUN,
PAK HUINAM,
LEE MOONHYOUNG,
JOUNG BOYOUNG
Publication year - 2012
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2012.03494.x
Subject(s) - medicine , atrial flutter , cardiology , tetralogy of fallot , tachycardia , ventricle , catheter ablation , heart disease , pulmonary atresia , atrioventricular septal defect , atrial tachycardia , ablation
Background: Radiofrequency catheter ablation (RFCA) for intraatrial reentrant tachycardia (IART) in congenital heart disease (CHD) remains difficult.Methods: Thirty‐four consecutive adult patients (age, 37.6 ± 12.8 years; male, 21) with previously repaired CHD and IART underwent an electrophysiological study and RFCA. CHD included atrial septal defect (ASD, n = 14), tetralogy of Fallot (n = 11), ventricular septal defect (n = 4), pulmonary atresia (n = 2), atrioventricular septal defect (n = 1), transposition of the great arteries (n = 1), and double‐outlet right ventricle (n = 1).Results: Duration of CHD repair to IART onset was 19.1 ± 8.5 years. Thirty and four patients had single‐ and double‐loop reentrant tachycardia, respectively. Among the total of 38 IARTs, which were mapped, 22 (57.9%) and 13 (34.2%) IARTs were cavotricuspid isthmus (CTI)‐dependent atrial flutter (AFL) and scar‐related AFL, respectively. Typical AFL electrocardiography findings including definite sawtooth appearance in inferior leads and positive F wave in lead V1 were observed in only 12 of 21 patients (57.1%) with CTI‐dependent AFL. CTI‐dependent AFL had a significantly longer tachycardia cycle length (TCL) than scar‐related AFL (267.6 ± 34.4 ms and 235.9 ± 37.0 ms, respectively; P = 0.031). TCL > 250 ms had 79% sensitivity as the cutoff value for differentiating CTI‐dependent from scar‐related AFL. The acute success rates of RFCA in CTI‐dependent and scar‐related AFLs were 85.7% and 90.0%, respectively. The recurrence rates in CTI‐dependent and scar‐related AFLs were 11.1% and 11.1%, respectively, during a follow‐up of 21.2 ± 28.3 months.Conclusions: CTI‐dependent AFL was the most common IART in adult patients with repaired CHD and was easily manageable by RFCA. TCL might help to differentiate CTI‐dependent AFL from other IARTs. (PACE 2012;35:1338–1347)