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Importance of tachycardia cycle length for differentiating typical atrial flutter from scar-related in adult congenital heart disease

Authors
 JAE-SUN UHM  ;  HEE-SUN MUN  ;  JIN WI  ;  JAEMIN SHIM  ;  HYE JIN HWANG  ;  JUNG-HOON SUNG  ;  JONG-YOUN KIM  ;  HUI-NAM PAK  ;  MOON-HYOUNG LEE  ;  BOYOUNG JOUNG 
Citation
 PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, Vol.35(11) : 1338-1347, 2012 
Journal Title
 PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY 
ISSN
 0147-8389 
Issue Date
2012
MeSH
Adult ; Atrial Flutter/complications ; Atrial Flutter/diagnosis* ; Cicatrix/complications* ; Cicatrix/diagnosis* ; Diagnosis, Differential ; Electrocardiography/methods ; Heart Defects, Congenital/complications* ; Heart Defects, Congenital/diagnosis* ; Humans ; Male ; Reproducibility of Results ; Sensitivity and Specificity ; Tachycardia, Ventricular/diagnosis* ; Tachycardia, Ventricular/etiology*
Keywords
Adult ; Atrial Flutter/complications ; Atrial Flutter/diagnosis* ; Cicatrix/complications* ; Cicatrix/diagnosis* ; Diagnosis, Differential ; Electrocardiography/methods ; Heart Defects, Congenital/complications* ; Heart Defects, Congenital/diagnosis* ; Humans ; Male ; Reproducibility of Results ; Sensitivity and Specificity ; Tachycardia, Ventricular/diagnosis* ; Tachycardia, Ventricular/etiology*
Abstract
BACKGROUND:  Radiofrequency catheter ablation (RFCA) for intraatrial reentrant tachycardia (IART) in congenital heart disease (CHD) remains difficult. METHODS:  Thirty-four consecutive adult patients (age, 37.6 ± 12.8 years; male, 21) with previously repaired CHD and IART underwent an electrophysiological study and RFCA. CHD included atrial septal defect (ASD, n = 14), tetralogy of Fallot (n = 11), ventricular septal defect (n = 4), pulmonary atresia (n = 2), atrioventricular septal defect (n = 1), transposition of the great arteries (n = 1), and double-outlet right ventricle (n = 1). RESULTS:  Duration of CHD repair to IART onset was 19.1 ± 8.5 years. Thirty and four patients had single- and double-loop reentrant tachycardia, respectively. Among the total of 38 IARTs, which were mapped, 22 (57.9%) and 13 (34.2%) IARTs were cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL) and scar-related AFL, respectively. Typical AFL electrocardiography findings including definite sawtooth appearance in inferior leads and positive F wave in lead V1 were observed in only 12 of 21 patients (57.1%) with CTI-dependent AFL. CTI-dependent AFL had a significantly longer tachycardia cycle length (TCL) than scar-related AFL (267.6 ± 34.4 ms and 235.9 ± 37.0 ms, respectively; P = 0.031). TCL > 250 ms had 79% sensitivity as the cutoff value for differentiating CTI-dependent from scar-related AFL. The acute success rates of RFCA in CTI-dependent and scar-related AFLs were 85.7% and 90.0%, respectively. The recurrence rates in CTI-dependent and scar-related AFLs were 11.1% and 11.1%, respectively, during a follow-up of 21.2 ± 28.3 months. CONCLUSIONS:  CTI-dependent AFL was the most common IART in adult patients with repaired CHD and was easily manageable by RFCA. TCL might help to differentiate CTI-dependent AFL from other IARTs
Full Text
http://onlinelibrary.wiley.com/doi/10.1111/j.1540-8159.2012.03494.x/abstract
DOI
22897504
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Jong Youn(김종윤) ORCID logo https://orcid.org/0000-0001-7040-8771
Mun, Hee Sun(문희선)
Pak, Hui Nam(박희남) ORCID logo https://orcid.org/0000-0002-3256-3620
Shim, Jae Min(심재민)
Uhm, Jae Sun(엄재선) ORCID logo https://orcid.org/0000-0002-1611-8172
Wi, Jin(위진) ORCID logo https://orcid.org/0000-0003-0655-5130
Lee, Moon Hyoung(이문형) ORCID logo https://orcid.org/0000-0002-7268-0741
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
Hwang, Hye Jin(황혜진)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/91626
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