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Catheter Ablation of Atrial Fibrillation in Patients with Cor Triatriatum Sinister; A Case Series and Review of the Literature
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  • Ahmadreza Karimianpour,
  • Amanda Cai,
  • Frank Cuoco,
  • John Sturdivant,
  • Sheldon Litwin,
  • J. Marcus Wharton
Ahmadreza Karimianpour
Medical University of South Carolina
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Amanda Cai
Medical University of South Carolina
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Frank Cuoco
Medical University of South Carolina
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John Sturdivant
Medical University of South Carolina
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Sheldon Litwin
Medical University of South Carolina
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J. Marcus Wharton
Medical University of South Carolina

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Abstract

Introduction: Cor triatriatum sinister (CTS) is a rare congenital heart defect associated with atrial fibrillation (AF). The incidence of hemodynamically insignificant CTS in the AF ablation population and its effect on ablation success are not known. Furthermore, little is known about the potential effect of CTS on arrhythmogenic substrate. Objective: We define the incidence of hemodynamically insignificant CTS in patients undergoing AF ablation with RF and cryoballoon ablation, the technical challenges created by the left atrial partitioning, and the potentially arrhythmogenic effects of the membrane. Methods: First-time AF ablation cases at our institution over a 10-year period were screened to identify and describe patients with CTS. Additionally, a PubMed/MEDLINE search was performed for a review of literature on patients with CTS undergoing CA of AF. Results: Of the 3,953 consecutive patients undergoing initial AF ablation during the study period, four patients (0.10%) had CTS. Ablation was successful acutely in all patients. One patient had recurrent AF and required repeat ablation for a single procedure success rate of 75% and multi-procedure success rate of 100%. The CTS membrane was associated with low voltage zones in the two patients in whom it was measured and with substrate for macro-reentrant atrial tachycardia in one of these patients. Conclusion: The incidence of hemodynamically insignificant CTS in patients undergoing CA for AF is very low, but does not serve as a significant barrier to successful ablation as long as pulmonary vein access is approached by directed access to the superoposterior chamber.