Noninvasive Characterization of Intra-Atrial Reentrant Tachyarrhythmias After Surgical Repair of Congenital Heart Diseases

Abstract

Intra-atrial reentrant tachyarrhythmia (IART) after surgical repair for congenital heart diseases (CHD) has not been noninvasively characterized. The 28 patients after surgery for CHD and 14 patients without surgery were investigated by 87-lead body surface mapping (BSM), 12-lead electrocardiogram (ECG), 20-lead signal averaged ECG (SAECG) and endocardial electroanatomical mapping (CARTO) during clockwise (CW: n=9) or counterclockwise (CCW: n=5) incisional atrial tachycardia (Incision-AT), CCW (n=23) or CW (n=4) cavotricuspid isthmus-dependent atrial flutter (CTI-AFL), and double-loop reentry (n=4). On the BSM, the isopotential map pattern and its locus of the minimum potential could differentiate the reentrant circuits, and the activation map revealed the reentrant circuits, which were highly coincident with those obtained from CARTO. On the 12-lead ECG, negative-positive polarity in the inferior leads or a discordant pattern in the precordial leads was observed in all cases of CTI-AFL, but 3/14 Incision-AT, positive polarity in lead V(1) was observed in all cases of CCW, but none of CW CTI-AFL, positive polarity in lead I was observed in all cases of CW, but none of CCW Incision-AT. Flutter-wave isopotential map and its activation sequence from the BSM predict reentrant circuits of IART after surgery for CHD. Flutter-wave polarity on the 12-lead ECG could differentiate these reentrant patterns.