Abstract 11582: Catheter Ablation of Supraventricular Tachycardia in Patients With Total Cavopulmonary Connection

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Keiko Toyohara ◽  
Tomomi Nishimura ◽  
Morio Shoda ◽  
Toshio Nakanishi
Keyword(s):  
Catheter Ablation ◽  
Supraventricular Tachycardia ◽  
Fontan Operation ◽  
Accessory Pathway ◽  
Total Cavopulmonary Connection ◽  
Transseptal Puncture ◽  
Atrioventricular Reentrant Tachycardia ◽  
Extracardiac Conduit ◽  
Lateral Tunnel ◽  
Cavopulmonary Connection

Introduction: Management of arrhythmias after the Fontan operation is difficult. Total cavopulmonary connection (TCPC), rather than atriopulmonary connection, is considered the optimal method to minimize the risk of arrhythmias, although they are sometimes still observed after TCPC. Catheter ablation (CA) for supraventricular tachycardia (SVT) is extremely difficult after TCPC because the systemic venous route is excluded from the atria. The purpose of this study was to evaluate the efficacy of CA in treating SVT after TCPC. Results: CA was attempted after TCPC in 14 patients aged 8-37 years (median: 23 years). TCPC was performed using the lateral tunnel approach in 5 patients, the intra-atrial conduit procedure in 2, and the extracardiac polytetrafluoroethylene conduit procedure in 7. During CA, the atrium was approached either by a transseptal puncture (12 patients), a fenestration in the patch (1 patient), or suture leakage (1 patient). Transseptal puncture was performed using a conventional Brockenbrough needle in all 12 patients. There were no clinically significant complications and only one unsuccessful puncture. SVT included atrial flutter in 4 patients, atrial tachycardia in 7, atrioventricular reentrant tachycardia (AVRT) via the accessory pathway in 1, and AVRT involving twin atrioventricular nodes in 2. Acute treatment of SVT with CA was achieved in 10 patients (71%), but tachycardia recurred in 3 during follow-up. Deterioration of cyanosis was not observed after transseptal puncture, and closure of the puncture site was confirmed in all 12 patients. Overall, SVT was successfully managed using CA in 7 out of 14 patients (50%), and with medication in the remaining patients. Conclusions: SVT may arise after the TCPC procedure. Puncture of the extracardiac conduit is feasible, and CA can be an effective treatment option for refractory SVT after TCPC.

scholarly journals Catheter ablation of supraventricular tachycardia in patients with total cavopulmonary connection

2013 ◽  
Vol 34 (suppl 1) ◽  
pp. P2315-P2315
Author(s):  
K. Ikeda ◽  
K. Toyohara ◽  
G. Izumi ◽  
D. Takeuchi ◽  
M. Shoda ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Supraventricular Tachycardia ◽  
Total Cavopulmonary Connection ◽  
Cavopulmonary Connection

scholarly journals Staged total cavopulmonary connection: serial comparison of intra-atrial lateral tunnel and extracardiac conduit taking account of current surgical adaptations

2019 ◽  
Vol 29 (3) ◽  
pp. 453-460 ◽  
Author(s):  
Eva van den Bosch ◽  
Sjoerd S M Bossers ◽  
Ad J J C Bogers ◽  
Daniëlle Robbers-Visser ◽  
Arie P J van Dijk ◽  
...  
Keyword(s):  
Overall Survival ◽  
Survival Rate ◽  
Total Cavopulmonary Connection ◽  
Overall Survival Rate ◽  
Free Survival ◽  
Patient Demographics ◽  
Extracardiac Conduit ◽  
Lateral Tunnel ◽  
Cavopulmonary Connection

AbstractOBJECTIVESOur goals were to compare the outcome of the intra-atrial lateral tunnel (ILT) and the extracardiac conduit (ECC) techniques for staged total cavopulmonary connection (TCPC) and to compare the current modifications of the TCPC technique, i.e. the prosthetic ILT technique with the current ECC technique with a ≥18-mm conduit.METHODSWe included patients who had undergone a staged TCPC between 1988 and 2008. Records were reviewed for patient demographics, operative details and events during follow-up (death, surgical and catheter-based reinterventions and arrhythmias).RESULTSOf the 208 patients included, 103 had the ILT (51 baffle, 52 prosthetic) technique and 105 had the ECC technique. Median follow-up duration was 13.2 years (interquartile range 9.5–16.3). At 15 years after the TCPC, the overall survival rate was comparable (81% ILT vs 89% ECC; P = 0.12). Freedom from late surgical and catheter-based reintervention was higher for patients who had ILT than for those who had ECC (63% vs 44%; P = 0.016). However, freedom from late arrhythmia was lower for patients who had ILT than for those who had ECC (71% vs 85%, P = 0.034). In a subgroup of patients who had the current TCPC technique, when we compared the use of a prosthetic ILT with ≥18-mm ECC, we found no differences in freedom from late arrhythmias (82% vs 86%, P = 0.64) or in freedom from late reinterventions (70% vs 52%, P = 0.14).CONCLUSIONSA comparison between the updated prosthetic ILT and current ≥18-mm ECC techniques revealed no differences in late arrhythmia-free survival or late reintervention-free survival. Overall, outcomes after the staged TCPC were relatively good and reinterventions occurred more frequently in the ECC group, whereas late arrhythmias were more common in the ILT group.

scholarly journals Exercise capacity in children after total cavopulmonary connection: Lateral tunnel versus extracardiac conduit technique

2014 ◽  
Vol 148 (4) ◽  
pp. 1490-1497 ◽  
Author(s):  
Sjoerd S.M. Bossers ◽  
Willem A. Helbing ◽  
Nienke Duppen ◽  
Irene M. Kuipers ◽  
Michiel Schokking ◽  
...  
Keyword(s):  
Exercise Capacity ◽  
Total Cavopulmonary Connection ◽  
Extracardiac Conduit ◽  
Lateral Tunnel ◽  
Cavopulmonary Connection

scholarly journals Exercise capacity in children after total cavopulmonary connection; lateral tunnel versus extracardiac conduit technique

2013 ◽  
Vol 34 (suppl 1) ◽  
pp. 128-128 ◽  
Author(s):  
S. S. M. Bossers ◽  
W. A. Helbing ◽  
N. Duppen ◽  
I. M. Kuipers ◽  
A. D. J. Ten Harkel ◽  
...  
Keyword(s):  
Exercise Capacity ◽  
Total Cavopulmonary Connection ◽  
Extracardiac Conduit ◽  
Lateral Tunnel ◽  
Cavopulmonary Connection

A Hemi Fontan Operation Performed by an Engineer: Considerations on Virtual Surgery

2013 ◽  
Author(s):  
Giovanni Biglino ◽  
Ethan Kung ◽  
Adam Dorfman ◽  
Andrew M. Taylor ◽  
Edward Bove ◽  
...  
Keyword(s):  
Blood Flow ◽  
Pulmonary Blood Flow ◽  
Fontan Operation ◽  
Hybrid Approach ◽  
Pulmonary Arteries ◽  
Virtual Surgery ◽  
Extracardiac Conduit ◽  
Lateral Tunnel ◽  
The Right ◽  
Cavopulmonary Connection

Single ventricle circulation, characterized at birth by a rudimentary or absent left or right ventricle, presents a challenging and life-threatening physiological scenario. Surgical palliation aims to restore the balance between systemic and pulmonary blood flow and is staged, each of the three stages presenting the surgeon with different options: - Stage 1 (Norwood procedure) involves different types of shunting to source pulmonary blood flow, or recently a hybrid approach [1]; - Stage 2 can involve a superior cavopulmonary connection (Glenn operation) or patching between the right atrium and the pulmonary arteries (Hemi Fontan operation [2]); - Stage 3 involves a total cavopulmonary connection with extracardiac conduit or lateral tunnel, or with novel alternatives such as the Y-graft [3].

scholarly journals Catheter ablation of macroreentrant atrial tachycardias following transconduit puncture access in a patient after total cavopulmonary connection with an extracardiac conduit

2021 ◽  
Vol 27 (3) ◽  
pp. 113-122
Author(s):  
Vassil Traykov ◽  
Tchavdar Shalganov ◽  
Lyubomir Dimitrov ◽  
Anna Kaneva ◽  
Stojan Lazarov ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Pulmonary Veins ◽  
Balloon Dilation ◽  
Right Atrial ◽  
Ventricular Rate ◽  
Complex Congenital Heart Disease ◽  
Total Cavopulmonary Connection ◽  
Surgical Interventions ◽  
Extracardiac Conduit ◽  
Cavopulmonary Connection

We present the case of a 23-year-old male diagnosed with a complex congenital heart disease (with single ventricle physiology) which necessitated many surgical interventions including total cavopulmonary connection. The patient presents with recurrent (almost daily) highly symptomatic atrial tachycardia with rapid ventricular rate and poor haemodynamic tolerance. Due to failure of antiarrhythmic drug therapy the patient was referred for catheter ablation. Atrial access was provided following transconduit puncture with a standard transseptal set. Crossing to the atrium with the transseptal introducer was not successful due to resistance from the conduit and the atrial wall. Therefore, balloon dilation of the puncture using a cutting balloon was carried out which resulted in easy crossing to the atrium with a steerable transseptal introducer. Several atrial tachyarrhythmias were induced two of which allowed mapping demonstrating a macroreentrant tachycardia dependent on the cavoannular isthmus as well as a complex fi gure-of-eight circuit involving right pulmonary veins and the right atrial appendage. Linear lesions transecting the critical isthmuses of the two circuits were delivered which rendered the patient noninducible. During a 9-month follow-up period the patient remained arrhythmia free.

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