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Ablation of Atrial Tachycardia in Adults With Congenital Heart Disease
Study Questions:
What are the outcomes and recurrence risks for ablation of atrial tachycardia in adult patients with congenital heart disease (ACHD) from a single center?
Methods:
This was a single-center retrospective review of all ACHD patients undergoing ablation for an atrial tachycardia over a 12-year period. The primary endpoints were acute success risk and time to recurrence. Predictors of these outcomes were determined by Cox proportional hazard model.
Results:
There were 140 patients included in the study (mean age 45 ± 1.2 years). One third had simple CHD (atrial septal defect, ventricular septal defect) and about 25% had severely complex CHD (atrial switch or Fontan). The acute success varied by substrate: 98% in cavotricuspid isthmus (CTI) dependent circuits and 80% in others. Recurrence risk was 44% within a median time of approximately 4 years. Few predictors of success or recurrence were identified. Complex patients and non-CTI dependent circuits predicted failure.
Conclusions:
Catheter ablation for atrial tachycardia in ACHD patients is an effective method of arrhythmia control.
Perspective:
Drawing useful conclusions from ablation results over a 12-year period from a population of ACHD patients with a broad disease severity is challenging. Outcomes for patients with complex CHD (Fontan or atrial switch) are known to be worse than in those with simpler CHD. Whether the recurrence risk of 44% constitutes ‘effective’ treatment is debatable, but with the lack of superior alternative options, catheter ablation for atrial tachycardia in ACHD will remain a hopeful, yet transient, therapy.
Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias, Cardiac Surgery and CHD and Pediatrics, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Interventions, CHD and Pediatrics and Quality Improvement, Interventions and Structural Heart Disease
Keywords: Arrhythmias, Cardiac, Catheter Ablation, Fontan Procedure, Heart Defects, Congenital, Heart Septal Defects, Atrial, Heart Septal Defects, Ventricular, Outcome Assessment, Health Care, Recurrence, Risk, Tachycardia, Supraventricular
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