Author + information
- Received January 15, 2019
- Revision received August 2, 2019
- Accepted August 2, 2019
- Published online December 16, 2019.
- Claire A. Martin, PhDa,b,c,∗ (, )
- Arthur Yue, MDd,
- Ruairidh Martin, MDa,e,
- Simon Claridge, MDd,
- Vinit Sawhney, MDc,
- Philippe Maury, MDf,
- Martin Lowe, PhDc,
- Nicolas Combes, MDg,
- Patrick Heck, MDb,
- David Begley, MDb,
- Simon Fynn, MDb,
- Richard Snowdon, MDh,
- Neil Seller, MDe,
- Stephen Murray, MDe,
- Ewen Shepherd, MDe,
- Vivienne Ezzat, MDc,
- Parag R. Gajendragadkar, MPhilb,
- Shohreh Honarbakhsh, MDc,
- Masateru Takigawa, PhDa,
- Ghassen Cheniti, MDa,
- Antonio Frontera, MDa,
- Nathaniel Thompson, MDa,
- Gregoire Massouillie, MDa,
- Takeshi Kitamura, MDa,
- Michael Wolf, MDa,
- Josselin Duchateau, PhDa,
- Nicholas Klotz, MDa,
- Konstantinos Vlachos, MDa,
- Felix Bourier, MDa,
- Anna Lam, MDa,
- Thomas Pambrun, MDa,
- Arnaud Denis, MDa,
- Frederic Sacher, PhDa,
- Hubert Cochet, MDa,
- Pierre Jais, MDa,
- Meleze Hocini, MDa,
- Michel Haissaguerre, MDa,
- Xavier Iriart, MDa,
- Jean-Benoît Thambo, MDa and
- Nicolas Derval, MDa
- aLIRYC/Hopital du Haut Leveque, Bordeaux, France
- bRoyal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
- cBarts Heart Centre, London, United Kingdom
- dUniversity Hospital Southampton, Southampton, United Kingdom
- eFreeman Hospital, Newcastle Upon Tyne, United Kingdom
- fHopital Rangueil, Toulouse, France
- gClinique Pasteur, Toulouse, France
- hLiverpool Heart and Chest Hospital National Health Service (NHS) Foundation Trust, Liverpool, United Kingdom
- ↵∗Address for correspondence:
Dr. Claire Martin, Service de Rythmologie, Hôpital Cardiologique du Haut-Lévêque, 1 Avenue Magellan, 33600 Pessac, France.
Objectives A new electroanatomic mapping system (Rhythmia, Boston Scientific, Marlborough, Massachusetts) using a 64-electrode mapping basket is now available; we systematically assessed its use in complex congenital heart disease (CHD).
Background The incidence of atrial arrhythmias post-surgery for CHD is high. Catheter ablation has emerged as an effective treatment, but is hampered by limitations in the mapping system’s ability to accurately define the tachycardia circuit.
Methods Mapping and ablation data of 61 patients with CHD (35 males, age 45 ± 14 years) from 8 tertiary centers were reviewed.
Results Causes were as follows: Transposition of Great Arteries (atrial switch) (n = 7); univentricular physiology (Fontans) (n = 8); Tetralogy of Fallot (n = 10); atrial septal defect (ASD) repair (n = 15); tricuspid valve (TV) anomalies (n = 10); and other (n = 11). The total number of atrial arrhythmias was 86. Circuits were predominantly around the tricuspid valve (n = 37), atriotomy scar (n = 10), or ASD patch (n = 4). Although the majority of peri-tricuspid circuits were cavo-tricuspid-isthmus dependent (n = 30), they could follow a complex route between the annulus and septal resection, ASD patch, coronary sinus, or atriotomy. Immediate ablation success was achieved in all but 2 cases; with follow-up of 12 ± 8 months, 7 patients had recurrence.
Conclusions We demonstrate the feasibility of the basket catheter for mapping complex CHD arrhythmias, including with transbaffle and transhepatic access. Although the circuits often involve predictable anatomic landmarks, the precise critical isthmus is often difficult to predict empirically. Ultra–high-density mapping enables elucidation of circuits in this complex anatomy and allows successful treatment at the isthmus with a minimal lesion set.
This research was supported by Institut Hospitalo-Universitaire L’Institut de Rythmologie et modélisation Cardiaque (IHU LIRYC) grant number ANR-10-IAHU-04. Drs. Sacher, Jais, Denis, Derval, and Yue have received modest consulting fees and speaking honoraria from Boston Scientific. Dr. Murray has been on the Advisory Board of Medtronic, St. Jude, and Boston Scientific; and has received travel expenses for meetings provided by St. Jude, Medtronic, Biosense Webster, and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received January 15, 2019.
- Revision received August 2, 2019.
- Accepted August 2, 2019.
- 2019 American College of Cardiology Foundation
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