Management of intra-atrial reentrant tachycardia

Abstract

Intraatrial reentrant tachycardia (IART), a difficult arrhythmia to manage, is likely to become more prevalent as the population of patients with congenital heart disease grows. While pharmacologic therapy alone often remains inadequate, important advances in nonpharmacologic therapy have occurred recently, enhancing the currently available therapeutic options. This review focuses on advances in electroanatomic mapping and catheter ablation, developments in arrhythmia surgery, and device therapy for IART. While catheter ablation for IART has high early recurrence rates, the lack of late recurrence in long-term follow-up is encouraging. Acute success may be improved with greater appreciation for reentrant circuits with current electroanatomic mapping systems, and with larger lesions that can be achieved with the use of irrigated-tip catheters. Arrhythmia surgery at the time of Fontan revision has good short-term and medium-term results, and is being studied as a prophylactic measure at initial Fontan surgery. Device therapy for IART now includes algorithms to prevent atrial arrhythmias, as well as antitachycardia pacing, which can be used safely and has very high efficacy for certain subgroups. Due to recent advances in mapping and ablation technology, coupled with developments in arrhythmia surgery and device therapy, the armamentarium of nonpharmacologic management of IART has become more potent. There are still, however, unique challenges posed by patients with congenital heart disease, and long-term follow-up in large numbers of patients with IART are required for this expanding population of patients.