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 (onewoman, mean age 21 ± 6 years) after correction of complexCHD: d-transposition of the great arteries (Mustard procedurein two patients, Senning procedure in two patients) and univentricularcirculation (total cavopulmonary connection in two patients,atriopulmonary connection in one patient). The ablation wasguided by a combination of electroanatomical mapping (CARTO,Biosense-Webster) and ICE (Acuson, Siemens). Intracardiac echocardiographywas used during mapping to identify relevant anatomical structuresand monitor tissue contact and for guidance of atrial bafflepuncture. Biatrial mapping was necessary in six of seven patientsand atrial baffle puncture in three. The clinical AT was abolishedin all patients. No complications were noted. During follow-upof 23 ± 13 months, two patients (28%) had arrhythmiarecurrence. One patient developed atrial fibrillation, and recurrentAT in the other patient was controlled by re-ablation. Conclusion: Despite complicated cardiac anatomy, catheter ablation of ATafter complex CHD can be performed safely and with a high successrate. Intracardiac echocardiography facilitates mapping, identificationof relevant cardiac structures, and could be used for safe guidanceof transbaffle puncture.