Key result
Transbaffle ablation using ultra-high density mapping successfully terminates atrial flutter in a post-Senning patient.
Why the study?
Management of persistent and symptomatic intra-atrial re-entrant tachycardia after Senning atrial switch operation requires advanced mapping and ablation techniques.
Does catheter ablation using ultra-high density electroanatomic mapping via a transbaffle approach terminate intra-atrial re-entrant tachycardia in a patient with a Senning operation?
Case Report (n=1)
Does catheter ablation using ultra-high density electroanatomic mapping via a transbaffle approach terminate intra-atrial re-entrant tachycardia in a patient with a Senning operation?
Ultra-high density electroanatomic mapping via a transbaffle approach successfully guided catheter ablation of intra-atrial re-entrant tachycardia in a patient with a prior Senning operation.
Supports feasibility of transbaffle ultra-high-density mapping-guided ablation in post-Senning IART; leaves open need for prospective studies before wider adoption.
A 36-year-old woman with d-transposition of the great arteries and Senning atrial switch operation was referred for catheter ablation of persistent and symptomatic intra-atrial re-entrant tachycardia. Catheter ablation was performed under general anaesthesia with Rhythmia™ system (Boston Scientific) for mapping. Activation map of the systemic venous atrium using Orion™ catheter (Boston Scientific) was completed within 9 min (19 379 electrograms) showing this atrium was bystander. We performed anterograde approach using modified trans-septal puncture of the atrial baffle under transoesophageal echocardiographic guidance. Activation map of pulmonary venous atrium achieved within 25 min (28 124 electrograms) revealed a counterclockwise typical flutter around tricuspid annulus with slow conduction and highly fractioned electrograms on lateral wall between annulus and posterior scar (Panel A). Ablation at this site rapidly slowed then terminated atrial flutter. We performed a 3rd activation map (11 min and 5802 electrograms), while pacing near the line in the inferior limb of the baffle to confirm complete block on lateral wall (Panel B). Tachycardia was no longer inducible at baseline and after isoproterenol infusion. Procedure lasted 180 min with 24 min of fluoroscopy. The patient had no recurrence after 3 months. The full-length version of this report can be viewed at: https://www.escardio.org/Education/E-Learning/Clinical-cases/Electrophysiology.
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Champ‐Rigot et al. (2018) conducted a case report in Intra-atrial re-entrant tachycardia post-Senning operation (n=1). Catheter ablation with ultra-high density electroanatomic mapping through transbaffle approach was evaluated on Tachycardia termination and recurrence. Catheter ablation using ultra-high density electroanatomic mapping through a transbaffle approach successfully terminated atrial flutter with no recurrence at 3 months in a post-Senning patient.
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