Importance of tachycardia cycle length for differentiating typical atrial flutter from scar-related in adult congenital heart disease

Jae Sun Uhm, Hee Sun Mun, Jin Wi, Jaemin Shim, Hye Jin Hwang, Jung Hoon Sung, Jong Youn Kim, Hui Nam Pak, Moon Hyoung Lee, Boyoung Joung

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

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)

Original languageEnglish
Pages (from-to)1338-1347
Number of pages10
JournalPACE - Pacing and Clinical Electrophysiology
Volume35
Issue number11
DOIs
Publication statusPublished - 2012 Nov 1
Externally publishedYes

Keywords

  • atrial flutter
  • cavotricuspid isthmus
  • congenital heart disease
  • intraatrial reentrant tachycardia
  • scar-related

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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