The safety and efficacy of trans-baffle puncture to enable catheter ablation of atrial tachycardias following the Mustard procedure: a single centre experience and literature review.

Background: Targets for catheter ablation of atrial tachyarrhythmias (AT) in post-Mustard procedure patients are often located in the pulmonary venous atrium (PVA). Traditional access to this chamber is retrograde via the aorta. However trans-baffle puncture may be a key determinant of successful ablation in many cases.

Methods: All AT ablations performed in patients late after Mustard and Senning operations by a single operator from 2007 to 2012 were reviewed.

Results: Nine procedures were identified. In total, 12 ATs were treated, seven persistent, the remainder induced, consisting of counterclockwise cavotricuspid isthmus dependent flutter (5), macroreentrant with isthmus in the systemic venous atrium (SVA) (2), macroreentrant with isthmus in the PVA (1), focal from the PVA (3), and focal from the SVA (1). Ablation within the PVA was required in all procedures to treat AT. Retrograde access in one patient was impossible due to the presence of a Bjork-Shiley tricuspid valve replacement; retrograde access in another two patients was attempted but catheter manipulation was ineffective and AT could not be mapped and ablated. Trans-baffle puncture was performed with transoesophageal echocardiographic guidance in all cases without complications and resulted in successful ablation of AT.

Conclusions: Access to the pulmonary venous atrium is essential for successful ablation of AT in many Mustard patients. Trans-baffle puncture remains a relevant technique to modern practice and can be performed safely and effectively.