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Hybrid approach to the elimination of atrioventricular nodal tachycardia by radiofrequency ablation in a patient after Fontan operation in the modification of extracardial condui

Authors: Filatov A.G., Samsonov V.B., Shalov R.Z., Kovalev D.V., Zelenikin M.M., Danilov T.Yu., Podzolkov V.P., Avanesyan G.A.

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, 121552, Russian Federation

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Type:  Case reports


DOI: https://doi.org/10.24022/1997-3187-2021-15-1-99-107

For citation: Filatov A.G., Samsonov V.B., Shalov R.Z., Kovalev D.V., Zelenikin M.M., Danilov T.Yu., Podzolkov V.P., Avanesyan G.A. Hybrid approach to the elimination of atrioventricular nodal tachycardia by radiofrequency ablation in a patient after Fontan operation in the modification of extracardial conduit. Creative Cardiology. 2021; 15 (1): 99–107 (in Russ.). DOI: 10.24022/1997-3187-2021-15-1-99-107

Received / Accepted:  16.03.2021 / 22.03.2021

Keywords: hybrid surgery radiofreguency ablation atrioventricular nodal tachycardia singl ventricle Fontan operation

Full text:  

 

Abstract

One of the long-term complications after Fontan operation is cardiac arrhythmias. Nodal atrioventricular tachycardia is extremely rare. In the absence of the effect of drug therapy, patients are shown intracardiac intervention in order to eliminate the source of arrhythmia. Radiofrequency ablation of an arrhythmogenic focus is considered the least traumatic and effective. At the same time, after Fontan operation, especially after modification with the use of an extracardiac conduit and the absence of fenestration, certain difficulties arise when choosing access to the intracardiac structures. An alternative can be a hybrid approach with the provision of intracardiac access to the conduction system for ablation using sterno- or thoracotomy in a cardiac surgery operating room. The presented message describes a hybrid approach to the elimination of arrhythmias.

References

  1. Weipert J., Noebauer C., Schreiber C., Kostolny M., Zrenner B., Wacker A. et al. Occurrence and management of atrial arrhythmia after long-term Fontan circulation. J. Thorac. Cardiovasc. Surg. 2004; 127: 457–64. DOI: 10.1016/j.jtcvs.2003.08.054
  2. Kim S., Kim W., Lim H., Lee J. Outcome of 200 patients after an extracardiac Fontan procedure. J. Thorac. Cardiovasc. Surg. 2008; 136 (1): 108–16. DOI: 10.1016/j.jtcvs.2007.12.032
  3. Pass R.H., Nappo L., Eugenio P., Lopez L. A transbaffle approach to ablation in a child with an extracardiac Fontan. Pacing Clin. Electrophysiol. 2010; 33: 368–71. DOI: 10.1111/j.1540- 8159.2009.02531.x
  4. Kerst G., Schranz D., Buttgereit K., Gonzalez M.B.G., Tuzcu V. Transcatheter creation of a de novo communication across an extracardiac Fontan conduit for catheter ablation of a “leftsided” accessory pathway. Clin. Res. Cardiol. 2014; 103: 165–8. DOI: 10.1007/s00392-013-0639-1 5. Plotnikova I.V., Dzhaffarova O.Yu., Svintsova L.I., Saushkin V.V., Kovalev I.A. Arrhythmias in children with a single ventricle. Bulletin of Siberian Medicine. 2018; 17 (2): 60–70 (in Russ.). DOI: 10.20538/1682-0363-2018-2-60-70
  5. Papagiannis J., Pillai A., Kaine S., TismaDupanovic S. Acquired right atrial appendage to right ventricle accessory pathway in a lateral tunnel Fontan patient: Successful ablation via transconduit approach. Heart Rhythm Case Rep. 2015; 1: 481–5. DOI: 10.1016/j.hrcr.2015.08.003
  6. Nehgme R.A., Carboni M.P., Care J., Murphy J.D. Transthoracic percutaneous access for electroanatomic mapping and catheter ablation of atrial tachycardia in patients with a lateral tunnel Fontan. Heart Rhythm. 2006; 3: 37–43. DOI: 10.1016/j.hrthm.2005.09.027
  7. Brown S.C., Boshoff D.E., Rega F., Eyskens B., Budts W., Heidbuchel H. et al. Transapical left ventricular access for dificult for each interventional targets in the left heart. Catheter. Cardiovasc. Interv. 2009; 74: 137–42. DOI: 10.1002/ccd.21939 9. Khairy P., Fournier A., Ruest P., Vobecky S.J. Transcatheter ablation via a sternotomy approach as a hybrid procedure in a univentricular heart. Pacing Clin. Electrophysiol. 2008; 31: 639–40. DOI: 10.1111/j.1540-8159.2008.01058.x
  8. Perry J.C., Boramanand N.K., Ing F.F. “Transseptal” technique through atrial baffles for 3-dimensional mapping and ablation of atrial tachycardia in patients with d-transposition of the great arteries. J. Interv. Card. Electrophysiol. 2003; 9: 365–9. DOI: 10.1023/a: 1027499512211
  9. Dave A.S., Aboulhosn J., Child J.S., Shivkumar K. Transconduit puncture for catheter ablation of atrial tachycardia in a patient with extracardiac fontan palliation. Heart Rhythm. 2010; 7: 413–6. DOI: 10.1016/j.hrthm.2009.10.037
  10. Aoki H., Nakamura Y., Takeno S., Takemura T. A new procedure for a trans-conduit puncture by grasping the dilator tip with a snare catheter: An alternative access method during catheter ablation of supraventricular tachycardias after an extracardiac Fontan operation. Heart Rhythm. 2014; 1–3. DOI: 10.1016/j.hrthm.2013.10.036
  11. Zin'kovskiy M.F. Congenital heart defects. 2009 (in Russ.).
  12. Moore J.P., Shannon K.M., Fish F.A., Seslar S.P., Garnreiter J.M., Krause U. et al. Catheter ablation of supraventricular tachyarrhythmia after extracardiac Fontan surgery. Heart Rhythm. 2016; 13 (9): 1891–7. DOI: 10.106/j.hrthm.2016.05.019
  13. Roy K., Gemez-Pulido F., Ernst S. Remote magnetic navigation system for catheter ablation in patients with congenital heart disease: a review. J. Cardiovasc. Electrophysiol. 2016; 27: S45–56. DOI: 10.1111/jce.12903
  14. Becker A.E., Wilkinson J.L., Anderson R.H. Atrioventricular conduction tissues: A guide in understanding the morphogenesis of the univentricular heart. In: Van Praagh R., Takao A. (Eds). Etiology and morphogenesis of congenital heart disease. Mount Kisco, NY, Futura; 1980.
  15. Putyato N.A., Shvedunova V.N., Astrakhantseva T.O., Samsonov V.B., Podzolkov V.P. Problems of the long-term period in patients after Fontan operation. Annals of the Russian Academy of Medical Sciences. 2009; 1: 33–7 (in Russ.).
  16. Shvedunova V.N., Zelenikin M.M., Putyato N.A., Pursanov M.G., Astrakhantseva T.O., Kovalev D.V. et al. The causes of readmissions after extracardiac Fontan surgery. The Bulletin of Bakoulev Center for Cardiovascular Diseases. 2018; 19 (5): 655–62 (in Russ.).
  17. Revishvili A.Sh., Podzolkov V.P., Artyukhina E.A., Baturkin L.Yu., Mchedlishvili K.A., Dzhitava T.G., Morskaya I.S. Interventional treatment of atrial arrhythmias in patients after Fontaine surgery. Annals of Arrhythmology. 2010; 4: 63–70 (in Russ.).

About Authors

  • Andrey G. Filatov, Dr. Med. Sc., Professor, Head of Department, ORCID
  • Viktor B. Samsonov, Dr. Med. Sc., Leading Researcher, ORCID
  • Ruslan Z. Shalov, Junior Researcher, ORCID
  • Dmitriy V. Kovalev, Dr. Med. Sc., Leading Researcher, ORCID
  • Mikhail M. Zelenikin, Dr. Med. Sc., Professor, Head of Department, ORCID
  • Timur Yu. Danilov, Dr. Med. Sc., Leading Researcher, ORCID
  • Vladimir P. Podzolkov, Dr. Med. Sc., Professor, Academician of RAS, Head of Department, ORCID
  • Grayr A. Avanesyan, Resident Physician, ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


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