Catheter Ablation of Atrial Arrhythmias After Cardiac Transplantation: Findings at EP Study Utility of 3-D Mapping and Outcomes

• Published in: Journal of cardiovascular electrophysiology Vol. 24; no. 5; pp. 498 - 502
• Main Authors: NOF, EYAL, STEVENSON, WILLIAM G., EPSTEIN, LAURENCE M., TEDROW, USHA B., KOPLAN, BRUCE A.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01-05-2013; Wiley Subscription Services, Inc
• Subjects: Arrhythmias, Cardiac - etiology; Arrhythmias, Cardiac - physiopathology; Arrhythmias, Cardiac - surgery; atrial arrhythmias; atrial flutter; Atrial Flutter - etiology; Atrial Flutter - surgery; atrial tachycardia; Cardiac arrhythmia; Catheter Ablation; Catheters; Echocardiography, Three-Dimensional; Electrocardiography; Female; Heart Atria; Heart Transplantation; Humans; Middle Aged; orthotopic heart transplant; Postoperative Complications - surgery; Tachycardia - etiology; Tachycardia - surgery; Time Factors
• ISSN: 1045-3873; 1540-8167
• DOI: 10.1111/jce.12078

Catheter Ablation of Atrial Arrhythmias
Background
Management of atrial arrhythmias (AA) in orthotopic heart transplant (OHT) patients is challenging.
Objective
The purpose of this study was to define the mechanisms of these arrhythmias and to evaluate the role of ablation.
Methods
Patients with OHT referred for ablation of AA from 1999 to 2011 were included (n = 15). Entrainment and anatomic 3‐D mapping were utilized to identify AA mechanism and guide ablation.
Results
The median time from OHT to ablation was 8 years (range: 1 month–16 years). AA types included 1 (7%) AVNRT, 5 (33%) cavotricuspid isthmus (CTI) dependent donor atrial flutter (AFl), 3 (20%) non‐CTI‐dependent donor AFL (n = 3), focal atrial tachycardia (AT) (n = 2) and in 4 (27%) recipient to donor atria conduction (RDC) that involved the right atrial anastomosis in 3 and left atrial anastamosis in 1 patient. In RDC tachycardia, ablation was performed at the site of earliest donor atrial activation on the suture line. AA in the recipient atria were not targeted. This resulted in acute success in all cases. In most patients 12/15 (80%) only right atrial ablation was necessary. Regardless of surgical technique (bicaval vs biatrial) right‐sided AA was most common. Acute success occurred in 14/15 (93%) patients and 3/15 (20%) required repeat Abl for recurrence. There were no major complications.
Conclusion
AA after OHT are most commonly due to atrial macroreentry, but focal arrhythmias and RDC atrial conduction also occur. Ablation of organized AA is usually successful with low risk, warranting early consideration in preference to medical treatment.