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Catheter ablation of complex atrial tachyarrhythmias in adult patients with cor triatriatum

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

Reports concerning clinical characteristics of cor triatriatum and approaches for catheter ablation of complex atrial tachyarrhythmias remain limited. Here, we describe successful catheter ablation treatments for complex atrial tachyarrhythmias in patients with cor triatriatum and address the clinical caveats.

Methods

Demographic characteristics, electrophysiologic findings, and ablation results in four patients with cor triatriatum were described.

Results

Catheter ablation was performed in four patients with cor triatriatum (three sinister and one dexter) and complex atrial arrhythmias (three with persistent atrial fibrillation (AF) and one with atypical left atrial flutter). A transseptal puncture was selectively directed into the accessory compartment containing the pulmonary veins. A comprehensive preview involving transthoracic echocardiography, transesophageal echocardiography, and computed tomography of the pulmonary veins was critical for proper positioning of ablation catheters. The pulmonary veins remain the major triggers or initiators for AF, and four pulmonary vein isolation procedures were sufficient to achieve successful results with negative inducibility test in the patients with AF. Heterogeneous conduction and complex fractionated signals were observed on the fibromuscular membrane. Atypical flutter was terminated during ablation over the connection between membrane and left atrial roof. The procedure was successfully performed on all patients without complications. No acute recurrences of atrial tachyarrhythmias were observed in any of the patients during short-term follow-up.

Conclusions

Catheter ablation is a feasible and efficient therapeutic strategy for treating complex atrial tachyarrhythmias in patients with cor triatriatum. Atrial remodeling due to anatomical obstruction or heterogeneous conduction of the fibromuscular membrane may serve as an arrhythmic substrate.

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Data availability

The data underlying in this study are incorporated in this article.

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Funding

This study received financial support from the Ministry of Science and Technology of Taiwan (MOST 107-2314-B-010-061-MY2, MOST 106-2314-B-010-046-MY3); Grant of TVGH (V108C-032, V109D48-001-MY2-1, C17-095); Research Foundation of Cardiovascular Medicine (107-02-036); and Szu-Yuan Research Foundation of Internal Medicine (No. 109015).

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Authors and Affiliations

  1. Heart Rhythm Center and Division of Cardiology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei, 11217, Taiwan

    Isaiah C. Lugtu, Yu-Feng Hu, Yenn-Jiang Lin, Rohit Walia, Chih-Min Liu, Shih-Lin Chang, Fa-Po Chung, Jo-Nan Liao, Li-Wei Lo & Shih-Ann Chen

  2. Heart Institute, Chinese General Hospital and Medical Center, Manila, Philippines

    Isaiah C. Lugtu

  3. Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan

    Yu-Feng Hu, Yenn-Jiang Lin, Shih-Lin Chang, Fa-Po Chung, Jo-Nan Liao, Li-Wei Lo & Shih-Ann Chen

  4. All India Institute of Medical Science, Rishikesh, Uttarakhand, India

    Rohit Walia

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  1. Isaiah C. Lugtu
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Correspondence to Yu-Feng Hu.

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Lugtu, I.C., Hu, YF., Lin, YJ. et al. Catheter ablation of complex atrial tachyarrhythmias in adult patients with cor triatriatum. J Interv Card Electrophysiol 62, 277–283 (2021). https://doi.org/10.1007/s10840-020-00888-7

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  • DOI: https://doi.org/10.1007/s10840-020-00888-7

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