AI Article Synopsis
- Patients with congenital heart defects often experience a high rate of macro-reentrant arrhythmias, with preoperative atrial fibrillation/flutter occurring in about 20% of cases and increasing by another 10% post-surgery.
- Surgical interventions like the Mustard and Senning procedures can see arrhythmia rates rise to 30%.
- Radiofrequency ablation shows promise as a treatment option, with a 77% success rate in isthmus-dependent flutter cases, though recurrence remains a challenge at 42%; advanced mapping systems are helpful in identifying problematic areas for ablation.
Article Abstract
Unlabelled: Patients with surgical correction of congenital cardiopathies have a high incidence of macro-reentrant arrhythmias. In previous reports the incidence of atrial fibrillation or flutter is around 20% preoperatively and increases to 10% more after surgery. In Mustard and Senning procedures the incidence could be as high as 30%. The physiopathology of these arrhythmias is due to conduction block and heterogeneity of refractory periods due to scaring and fibrosis left by the surgical procedure. Radiofrequency ablation is a good treatment option in this patients, but with conventional approaches the percentage of success is lower and with higher recurrence. In our institution out of 39 patients with macro-reentrant atrial tachycardia, acute success was 77% in patients with isthmus dependent flutter and 44% if the Isthmus was not part of the circuit. Recurrence in both groups was 42%. New mappings systems like Localisa, CARTO an NavX, are useful to localize areas of scar and block, that produce multiple conduction channels that can participate in reentrant arrhythmias. Radiofrequency ablation of these channels is up to day the ideal approach for these patients.
Conclusions: Arrhythmias in patients with congenital cardiopathies are frequent and complicate the evolutions of these patients. Radiofrequency ablation is the treatment of choice in centers with experience. The use of non fluoroscopic electroanatomic mapping systems is of great help in this setting.
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