Catheter ablation of atrial fibrillation in patients with cor triatriatum sinister; case series and review of literature

Autor:	Amanda W. Cai, Sheldon E. Litwin, Frank Cuoco, John Lacy Sturdivant, John Marcus Wharton, Ahmadreza Karimianpour
Rok vydání:	2021
Předmět:	medicine.medical_specialty medicine.medical_treatment Population Catheter ablation Cor Triatriatum Internal medicine Atrial Fibrillation medicine Humans In patient education Atrial tachycardia education.field_of_study business.industry Incidence (epidemiology) Atrial fibrillation General Medicine Ablation medicine.disease nervous system diseases Cor triatriatum sinister Catheter Ablation Cardiology medicine.symptom Cardiology and Cardiovascular Medicine business
Zdroj:	Pacing and Clinical Electrophysiology. 44:2084-2091
ISSN:	1540-8159 0147-8389
DOI:	10.1111/pace.14371
Popis:	INTRODUCTION Cor triatriatum sinister (CTS) is a rare congenital heart defect characterized by fibromuscular septation of the left atrium associated with atrial fibrillation (AF). The incidence of hemodynamically insignificant CTS in the AF ablation population and effect on ablation success are not known. Furthermore, little is known about the potential effect of CTS on arrhythmogenic substrate. OBJECTIVE We define the incidence of hemodynamically insignificant CTS in patients undergoing AF ablation with RF and cryoballoon ablation, the technical challenges created by the left atrial partitioning, and the potentially arrhythmogenic effects of the membrane. We also review the literature of CA in patients with CTS. METHODS First-time AF ablation cases at our institution over a 10-year period were screened to identify patients with CTS. Retrospective review was performed to obtain clinical characteristics and ablation data. RESULTS Of the 3953 consecutive patients undergoing initial AF ablation during the study period, four patients (0.10%) had CTS. Ablation was successful acutely in all patients. One patient had recurrent AF and required repeat ablation for a single procedure success rate of 75% and multi-procedure success rate of 100%. The CTS membrane was associated with low voltage zones in the two patients in whom it was measured and with substrate for macro-reentrant atrial tachycardia in one of these patients. CONCLUSION The incidence of hemodynamically insignificant CTS in patients undergoing CA for AF is very low, but does not serve as a significant barrier to successful ablation as long as directed access to the superoposterior chamber is obtained.
Databáze:	OpenAIRE
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