Volume 2, Issue 1, Pages (January 2005)

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Volume 2, Issue 1, Pages 64-72 (January 2005) Ablation of atrial tachycardia after surgery for congenital and acquired heart disease using an electroanatomic mapping system: Which circuits to expect in which substrate? Peter Lukac, MD, Anders K. Pedersen, MD, DMSc, Peter T. Mortensen, MD, Henrik K. Jensen, MD, Phd, DMSc, Vibeke Hjortdal, MD, PhD, DMSc, Peter S. Hansen, MD, PhD, DMSc Heart Rhythm Volume 2, Issue 1, Pages 64-72 (January 2005) DOI: 10.1016/j.hrthm.2004.10.034 Copyright © 2005 Heart Rhythm Society Terms and Conditions

Figure 1 Right lateral atriotomy. An incision in the right atrial wall parallel to the tricuspid annulus is made. IVC = inferior vena cava; LA = left atrium; RA = right atrium; SVC = superior vena cava; TV = tricuspid valve. Heart Rhythm 2005 2, 64-72DOI: (10.1016/j.hrthm.2004.10.034) Copyright © 2005 Heart Rhythm Society Terms and Conditions

Figure 2 Superior transseptal approach. An incision in the right atrium is prolonged deeply into the septum and to the roof of the left atrium. IAS = interatrial septum; IVC = inferior vena cava; LA = left atrium; PV = pulmonary vein; RA = right atrium; SVC = superior vena cava. Heart Rhythm 2005 2, 64-72DOI: (10.1016/j.hrthm.2004.10.034) Copyright © 2005 Heart Rhythm Society Terms and Conditions

Figure 3 Left atrial approach to the mitral valve. A left atrial incision parallel to the interatrial groove is made. IVC = inferior vena cava; MV = mitral valve; PV = pulmonary vein; RA = right atrium; SVC = superior vena cava. Heart Rhythm 2005 2, 64-72DOI: (10.1016/j.hrthm.2004.10.034) Copyright © 2005 Heart Rhythm Society Terms and Conditions

Figure 4 Incisional atrial tachycardia in a patient after mitral valve replacement. The central obstacle is formed by the right atrial part of the superior transseptal incision. Electroanatomic activation map is shown in the left anterior oblique view. Yellow line represents the direction of activation. Orange point marks the position of the His bundle. Light blue points indicate double potentials. No electrically inactive tissue was found in the vicinity of the incision in this patient. CS = coronary sinus; TA = tricuspid annulus. Heart Rhythm 2005 2, 64-72DOI: (10.1016/j.hrthm.2004.10.034) Copyright © 2005 Heart Rhythm Society Terms and Conditions

Figure 5 Incisional tachycardia in a patient after biatrial heart transplantation. Electroanatomic activation map of the left atrium is shown in the left anterior oblique projection. The activation wavefront (yellow line) is circulating around the mitral annulus bounded posteriorly by the old atrium (gray area). A series of ablations (red points) that connected the mitral annulus with the old atrium cured the patient. MA = mitral annulus. Heart Rhythm 2005 2, 64-72DOI: (10.1016/j.hrthm.2004.10.034) Copyright © 2005 Heart Rhythm Society Terms and Conditions

Figure 6 Isthmus-dependent flutter in a patient after Mustard operation. Electroanatomic activation map of both atria is displayed in the left anterior oblique projection. The yellow line signifies clockwise rotation of the activation wavefront around the tricuspid annulus. Ablation lesions in both atria (red dots) were needed to cure the flutter. Ablation points in the pulmonary venous atrium are marked with the vertical arrow and the ablation point in the systemic venous atrium with the horizontal arrow. Gray area in the septum denotes electrically inactive tissue, most probably the baffle. blue = systemic venous atrium; IVC = inferior vena cava; MA = mitral annulus; PV = pulmonary veins; red = pulmonary venous atrium; TA = tricuspid annulus. Heart Rhythm 2005 2, 64-72DOI: (10.1016/j.hrthm.2004.10.034) Copyright © 2005 Heart Rhythm Society Terms and Conditions

Figure 7 Ablation sites used to treat incisional atrial tachycardia with the central obstacle on the right atrial free wall. A schematic of the right atrium is shown in the anteroposterior view. Numbers represent number of patients, where the respective lesion was used. Line with arrow represents the activation wavefront of incisional atrial tachycardia. ABL = ablation lesion; IVC = inferior vena cava; SCAR = scar of the atriotomy or patch; SVC = superior vena cava; TA = tricuspid annulus. Heart Rhythm 2005 2, 64-72DOI: (10.1016/j.hrthm.2004.10.034) Copyright © 2005 Heart Rhythm Society Terms and Conditions