"SUCCESSFUL ABLATION OF ATRIAL FLUTTER THROUGH A TRANS-BAFFLE APPROACH " by Lama N. Al Jebbawi, Anthony McClafferty et al.
 

SUCCESSFUL ABLATION OF ATRIAL FLUTTER THROUGH A TRANS-BAFFLE APPROACH IN A PATIENT WITH MUSTARD REPAIR OF D-TRANSPOSITION OF THE GREAT ARTERIES(D-TGA)

Document Type

Conference Proceeding

Publication Date

4-2-2024

Publication Title

J Am Coll Cardiol

Abstract

Background Atrial switch repair in d-TGA is a substrate for atrial tachyarrhythmias (AT). Due to complex anatomical and hemodynamic changes, therapies are often challenging. Case A 54-year-old male with d-TGA and Mustard repair in 1974, presented with symptomatic atrial flutter (AF). Different treatments were discussed with the patient, who opted for catheter ablation. Decision-making AT isthmus-dependent reentry is most common (77%) in this population. Ablation can be achieved through aortic retrograde approach or via a transbaffle approach. Both pose considerable technical challenges, requiring a precise understanding of the anatomy of the surgically modified chambers. During the procedure, AF was induced with a cycle length (CL) of 270 ms. Using the CARTO system, an electroanatomic map of the morphological left atrium was performed where entrainment mapping showed a long PPI-TCL. Guided by intracardiac echocardiogram, a transbaffle puncture was performed to access and map the systemic right atrium. Entrainment showed a PPI-TCL of 0ms around the systemic tricuspid valve. Ablation was performed from the valve plane to the left superior pulmonary vein. Local electrograms were eliminated with bidirectional block confirmation. Conclusion With the unsatisfactory outcomes of rhythm control, pacing, and cardioversion in atrial switch-related AT, catheter ablation can be therapeutic. An understanding of AT mechanisms, altered anatomy, and procedural adaptation is key to achieve success. [Formula presented]

Volume

83

Issue

13

First Page

2944

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