Play the Map: Ablation of a Macro Reentrant Atrial Tachycardia in a Patient After Senning Repair for Transposition of the Great Arteries

Abstract: A 50-year-old male patient who had undergone Senning repair for transposition of the great arteries at the age of 7 years was referred to our electrophysiology lab with recurrent supraventricular tachycardias. Fast anatomical mapping of the systemic venous atrium was performed with the CARTO electroanatomical mapping system. Propagation mapping with animated dynamic maps facilitates the understanding of the underlying mechanism and provides visualization of reentrant circuits of tachycardias in cardiac chambers with native barriers and surgical scars.

J INVASIVE CARDIOL 2017;29(1):E13.

Key words: CARTO anatomical mapping, supraventricular tachycardias

A 50-year-old male patient who had undergone Senning repair for transposition of the great arteries at the age of 7 years was referred to our electrophysiology lab with recurrent supraventricular tachycardias. Sustained atrial tachycardia (cycle length, 440 ms) could be induced by atrial burst pacing. Fast anatomical mapping of the systemic venous atrium was performed with the CARTO electroanatomical mapping system using an 8 Fr, 4 mm Navistar catheter (Biosense Webster) and the pulmonary venous atrium (PVA) was mapped using a retrograde aortic approach. Activation mapping showed the earliest atrial activation in the area between pulmonary venous baffle and tricuspid annulus. Propagation mapping demonstrated a macroreentrant atrial tachycardia propagating in counter-clockwise rotation along tricuspid annulus and PVA (Figure 1 and Video 1). Linear ablation was performed between the pulmonary venous baffle and tricuspid annulus, thereby terminating the tachycardia.

Macroreentrant atrial tachycardias that occur in patients after surgical repair of congenital heart defects are generally based on complex structural abnormalities. In addition to having profound knowledge of the exact cardiac anatomy and its surgical modifications, defining the mechanism of arrhythmia is crucial. Propagation mapping with animated dynamic maps facilitates the understanding of the underlying mechanism and provides visualization of reentrant circuits of tachycardias in cardiac chambers with native barriers and surgical scars.

From the University Heart Center, Zurich University Hospital, Zurich, Switzerland.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Yalcinkaya reports grant support from the European Society of Cardiology (Training Fellow in Electrophysiology). The remaining authors report no conflicts of interest regarding the content herein.

Manuscript submitted July 8, 2016 and accepted July 11, 2016.

Address for correspondence: Emre Yalcinkaya, MD, FESC, Zurich University Hospital, Arrhythmia and Electrophysiology Division, University Heart Center, 8091, Zurich, Switzerland. Email: emre.yalcinkaya@usz.ch