Key result
Transbaffle access to the pulmonary venous atrium for ablation of atrial re-entrant tachycardia was successfully established in 9 of 10 procedures without major complications or residual shunt.
Why the study?
Is transbaffle access to the pulmonary venous atrium feasible and safe for catheter ablation of atrial re-entrant tachycardia in adult patients with congenital heart disease?
Observational (n=8)
Is transbaffle access to the pulmonary venous atrium feasible and safe for catheter ablation of atrial re-entrant tachycardia in adult patients with congenital heart disease?
Transbaffle access for catheter ablation of atrial re-entrant tachycardia in the pulmonary venous atrium is feasible and safe in patients with prior Mustard or Fontan procedures.
Supports transbaffle access as a potential option in select congenital cases; leaves open need for larger prospective validation before wider adoption.
AIMS: Catheter ablation of atrial re-entrant tachycardia in patients after atrial switch procedure for transposition of the great arteries or with a Fontan circulation is technically challenging if the critical part of the re-entry circuit is located within the pulmonary venous atrium (PVA). We report our experience in transbaffle access (TBA) to the PVA for ablation of atrial re-entrant tachycardia focusing on technical details. METHODS AND RESULTS: In eight patients, six after Mustard procedure and two with a Fontan circulation, endocardial mapping of atrial re-entrant tachycardia revealed the critical part of the re-entry circuit within the PVA. A total of 10 ablation procedures were performed. Detailed angiographic assessment of the anatomy of the systemic and pulmonary venous atria was performed prior to baffle puncture. Transbaffle access was successfully established with a standard transseptal needle in 9 of 10 procedures. No major complications occurred. At the end of the procedure and the removal of the transseptal sheath, there was no residual shunt in any patient. CONCLUSION: Transbaffle access to the PVA for ablation of atrial re-entrant tachycardia is feasible, less invasive than alternative approaches and can be safely applied in patients after Mustard procedure or with a Fontan circulation. However, the rigidity of prosthetic material may preclude baffle puncture at least in a subset of those patients.
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Krause et al. (2015) conducted an observational in Atrial re-entrant tachycardia in congenital heart disease (n=8). Transbaffle access for catheter ablation was evaluated on Successful transbaffle access. Transbaffle access to the pulmonary venous atrium for ablation of atrial re-entrant tachycardia was successfully established in 9 of 10 procedures without major complications or residual shunt.
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