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Catheter ablation of atrial fibrillation in situs inversus dextrocardia: Challenge, improved procedure, outcomes, and literature review
Ist Teil von
Pacing and clinical electrophysiology, 2021-02, Vol.44 (2), p.293-305
Ort / Verlag
United States: Wiley Subscription Services, Inc
Erscheinungsjahr
2021
Quelle
Wiley Online Library - AutoHoldings Journals
Beschreibungen/Notizen
Introduction
Catheter ablation for atrial fibrillation (AF‐CA) in patients with situs inversus dextrocardia (SID) can be challenging because of the contrary anatomy and associated anomalies. Cases and literature regarding AF‐CA in SID are rare and provide little information. Our study aims to present an improved procedure, ablation strategies, and evaluate the safety and outcomes of AF‐CA in patients with AF and SID.
Methods
A total of 10 patients with AF‐SID (mean age, 60.4 ± 15.7 years; six paroxysmal AF, four persistent atrial fibrillation [PeAF]) were enrolled. For the improved procedure, images obtained by preacquired computed tomography and three‐dimensional electroanatomical mapping, integrating intracardiac echocardiography, and x‐ray imaging data are necessary to optimize the transseptal puncture and ablation procedure.
Results
All patients successfully underwent 13 AF‐CA procedures without complications, including three patients received repeat procedures. However, two PeAF patients presented sick sinus syndrome (SSS) after the AF‐CA procedure, and one underwent permanent pacemaker implantation therapy during hospitalization. During the follow‐up period (6‐72 months), the outcomes were not favorable: three patients (30%) maintained sinus rhythm (SR) after the initial procedure; after repeated procedures, the overall SR rate was 40% (four patients).
Conclusion
With the improved strategy, AF‐CA can be safely and effectively performed with low radiation exposure in patients with SID. However, the long‐term outcomes were not favorable, even when managed at a tertiary center by a team of specialists. Moreover, patients with PeAF might also have masked SSS, which should be carefully considered.