Clin Res Cardiol 100, Suppl 1, April 2011

V1505 - Acute and Long-Term Outcome after Catheter Ablation of Supraventricular Tachycardia in Patients after the Mustard or Senning Operation for d-Transposition of the Great Arteries
J. Wu1, S. Ammar1, T. Reents1, S. Fichtner1, C. Jilek1, H. Esnter1, P. Zhu1, J. Hess1, I. Deisenhofer1, G. Hessling1
1Deutsches Herzzentrum München, München;
Background: Data about the long-term outcome of catheter ablation in patients (pts) with d-Transposition of the great arteries (d-TGA) after the Mustard and Senning operation are scarce.
Objective: This single center retrospective study reviewed acute success and long-term follow-up after catheter ablation in patients (pts) with d-TGA after the Mustard/Senning operation. 
The study included 27 pts (mean age 28.7±6.7 years, 9 females) after a Mustard (n=16) or Senning (n=11) procedure who underwent catheter ablation for supraventricular tachycardia from January 2004 to July 2010. 
The 3D-mapping system (Carto) was used for every procedure (in combination with remote magnetic navigation (RMN) in 14 procedures).  Tachycardia mechanism was (1) atrial tachycardia (AT) including intraatrial reentrant tachycardia (IART) or focal atrial tachycardia (FAT) or (2) atrioventricular node reentrant tachycardia (AVNRT). 
Ablation using an irrigated-tip catheter was performed manually (n=26) or by RMN (n=9). For IART an ablation of the critical isthmus was performed. In case of FAT, the site with earliest local activation time was ablated. Slow pathway modulation was performed in patients with AVNRT. Acute ablation success was defined as termination of AT or non-inductivity of AVNRT after ablation.
Follow-up was available 3, 6 and 12 months after ablation and yearly thereafter. Freedom from tachycardia was defined as long-term success. The acute and long-term follow-up results were grouped according to the ablation years: 2004-2005, 2006-2008 and 2009-2010.
In the 27 pts, a total of 35 ablations were performed including one (n=20), two (n=6) or three (n=1) ablations. Tachycardia mechanism was AT (n=22), AVNRT (n=2) and a combination of AT and AVNRT (n=3).  There were 36 tachycardia forms (AT n=31 and AVNRT n=5) with a mean cycle length of 275.2±49.5ms (AT) and 452.0±77.9ms (AVNRT). Peritricuspid atrial flutter (n=24) was the most common AT type.  
Ablation was performed manually (n=26) or remotely navigated by RMN (n=9) with an acute success in 30/35 (86%).  Acute ablation success in AT was 84% (24/31 procedures). AT ablation was performed only in the SVA (n=3), only in the PVA (n=15) or in both atria (n=13). The 5 unsuccessful ablations were in 4 patients with peritricuspid flutter (n=4) or FAT (n=1). Successful slow-pathway ablation was performed in all 5 AVNRT procedures.
Mean fluoroscopy time of the procedure was 28.2±20.7min (AT 28.6±20.4min and AVNRT 26±24.6min) and the mean procedure duration was 290.9±107.6 min (AT 283±111.8min; AVNRT 329±89.7min).
After the first ablation, recurrence occurred in 8/25 (32%) AT pts and 0/5 AVNRT pts after a mean of of 13±13.6 months. After a mean follow-up time of 29.1±24.5 months, 26/27 (96.2%) patients were free of AT/AVNRT.
Results according to year of ablation are shown in Figure 1. There was a tendency towards higher acute and long-term success in the last 2 years using exclusively RMN.


Figure1. Comparisons of acute and long-time success of AT ablation in 2004-2005, 2006-2008 and 2009-2010.

Catheter ablation of AT or AVNRT in patients after the Mustard or Senning operation for d-TGA has a high acute success rate. Patients with AT had a recurrence rate of about 30%. However, after a second ablation, long-term results are excellent.

Clin Res Cardiol 100, Suppl 1, April 2011
Zitierung mit Vortrags- oder Posternummer s.o.
DOI 10.1007/s00392-011-1100-y