Arrhythmogenic Substrates and Catheter Ablation of Supraventricular Tachycardia after Surgical Repair of Congenital Heart Disease

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Purpose: We investigated the methods of identifying and ablating the substrates of supraventricular tachycardia (SVT) after surgical repair of congenital heart disease (CHD) from the voltage map using CARTO, and to assess the effect of catheter ablation. Methods: Forty-eight patients (22 male, 22±13 years after surgery) with palpitation or symptomatic arrhythmias after surgical repair of CHD (23 TOF, 13 ASD, 6 VSD, 2 Fontan, 2 Mustard, 1 Senning, and 1 Rastelli) were studied. A high density CARTO map of RA was obtained during SVT or SR in each patient. Results: Although 32 patients had SVT previously, SVTs were provoked in 42 patients (87%). Typical AFL and AT were provoked in 12 patients. Only typical AFL was induced in 12 patients. Every AT was macro-reentrant. Thirty patients with AT had scars within low voltage area in RA free wall, which formed a channel. All SVTs were eliminated by catheter ablation in 39 patients (92%). There was no complication and only one recurrence of SVT in all patients during follow-up 34±22 months. Conclusion: Arrhythmogenic substrates of SVT can be identified by high density voltage mapping of RA with CARTO. It is clear that many patients who have any sort of atriotomy are at risk for typical AFL. The results may facilitate catheter ablation of SVT after surgical repair of CHD.