Ablation of atrial tachycardias after correction of complex congenital heart diseases: utility of intracardiac echocardiography

AIMS: Our goal was to analyse the utility of intracardiac echocardiography (ICE) for navigation and ablation of atrial tachycardias (ATs) after surgical correction of congenital heart disease (CHD). METHODS AND RESULTS: Catheter ablation of ATs was performed in seven patients (one woman, mean age 21 +/- 6 years) after correction of complex CHD: d-transposition of the great arteries (Mustard procedure in two patients, Senning procedure in two patients) and univentricular circulation (total cavopulmonary connection in two patients, atriopulmonary connection in one patient). The ablation was guided by a combination of electroanatomical mapping (CARTO, Biosense-Webster) and ICE (Acuson, Siemens). Intracardiac echocardiography was used during mapping to identify relevant anatomical structures and monitor tissue contact and for guidance of atrial baffle puncture. Biatrial mapping was necessary in six of seven patients and atrial baffle puncture in three. The clinical AT was abolished in all patients. No complications were noted. During follow-up of 23 +/- 13 months, two patients (28%) had arrhythmia recurrence. One patient developed atrial fibrillation, and recurrent AT in the other patient was controlled by re-ablation. CONCLUSION: Despite complicated cardiac anatomy, catheter ablation of AT after complex CHD can be performed safely and with a high success rate. Intracardiac echocardiography facilitates mapping, identification of relevant cardiac structures, and could be used for safe guidance of transbaffle puncture.