Catheter Ablation -> Atrial Fibrillation & Atrial Flutter: -> Ablation Techniques D-PO02 - Poster Session II (ID 47) Poster

D-PO02-127 - Catheter Ablation Of Complex Atrial Tachyarrhythmias In Adult Patients With Cor Triatriatum (ID 218)


Background: Cor triatriatum (CT) is a rare congenital heart disease wherein a fibromuscular membrane divides the right or left atrium into two compartments resulting in a triatrial heart.
Objective: To understand the caveat of catheter ablation treatments for complex atrial tachyarrhythmias in patients with CT.
Methods: Demographic characteristics, electrophysiologic findings, and ablation results in four patients with CT were analyzed.
Results: Catheter ablation was performed in 4 patients with CT (3 sinisters and 1 dexter) and complex atrial arrhythmias (3 with persistent atrial fibrillation (AF) and 1 with atypical left atrial flutter). The transseptal puncture needed to be selectively directed into the accessory compartment containing the pulmonary veins (PV). Review of the transthoracic/transesophageal echocardiography and computed tomography of the PV was critical for proper catheter positioning. The PVs remain the major triggers for AF, and four PV isolation was sufficient to achieve successful results (Figure 1). Heterogeneous conduction and complex fractionated signals were observed on the membrane. Atypical flutter was terminated during ablation over the connection between membrane and left atrial roof in one patient. Procedures were successfully performed on all patients without complications. No acute recurrences of atrial arrhythmias were observed during follow-up.
Conclusion: Catheter ablation is a feasible and efficient therapeutic strategy for treating complex atrial arrhythmias in patients with CT. Atrial remodeling due to anatomical obstruction or heterogeneous conduction of the fibromuscular membrane may serve as an arrhythmic substrate.