Delineation of intra-atrial reentrant XXXX circuits after mustard operation for transposition of the great arteries using biatrial electroanatomic mapping and entrainment mapping.

@entity591 @entity1 @entity1211 @entity4710
INTRODUCTION: Intra-atrial reentrant @entity591 (IART) circuits after Mustard operation remain incompletely understood due to the complex atrial anatomy after extensive surgical procedures. The aim of this study was to delineate IART circuits and their relations to the individual anatomic boundaries in Mustard @entity1 . METHODS AND RESULTS: Twelve @entity1 (10 @entity1 and 2 @entity1 ; age 29 +/- 4.6 years) with @entity4710 after Mustard operation were included in this study. During 14 IARTs and 2 focal @entity591 , electroanatomic mapping and entrainment mapping were performed in both the @entity1211 . The latter was accessed via a retrograde transaortic approach. Thirteen IARTs used a single-loop reentrant circuit, and 1 IART used a dual-loop reentrant circuit. Ten (77%) of 13 single-loop reentrant circuits used the tricuspid annulus (TA) as their central barrier. The remaining 3 IARTs rotated around the inferior vena cava (IVC) (n = 2) or ostium of the right upper pulmonary vein (n = 1). In 6 (60%) of the 10 peritricuspid IARTs, both @entity1211 components of the mid-portion of the TA-IVC isthmus were demonstrated to be part of the reentry. Overall, 12 (86%) of 14 IARTs in 10 @entity1 were successfully ablated by bridging two barriers that constrained the reentrant circuit. Eight (80%) of 10 peritricuspid circuits were abolished by linear ablation connecting the TA to the IVC (n = 4), incisional scar (n = 2), patch (n = 1), and atriotomy (n = 1). CONCLUSIONS: In Mustard @entity1 , the TA serves as the most frequent central barrier of IART. Biatrial electroanatomic mapping combined with entrainment mapping facilitates delineation of IART circuits in relation to their anatomic barriers and enables the design of individual ablation strategies to achieve high success.
