Preliminary Results of Cryoablation for Surgical Treatment of Arrhythmias in Adults With Congenital Heart Disease

Abstract

Background: Arrhythmias in adult congenital heart disease (ACHD) are responsible for the majority of hospital admissions and 20–25% of late deaths. Since need for further cardiac operations is frequent in ACHD, concomitant arrhythmia surgery represents a strategic treatment modality.Material and Methods: A two-center retrospective study was undertaken on cryoablation of supraventricular arrhythmias in 25 conescutive ACHD patients (16/9, M/F, median age 38.5 years, IQR 38–60) operated between 01/2017 and 12/2020. Nineteen (76%) had undergone one or more previous cardiac operations and 8 (32%) one or more trans-catheter ablations. Indications included Fontan conversion in seven patients, septal defect repair in 6, pulmonary valve replacement in 10 and tricuspid surgery in 2. Open-heart cryoablation included: 4 cavotricuspid isthmus ablations, 19 right-sided Maze for atrial tachycardia/flutter, and 2 Cox-Maze III for atrial fibrillation.Results: There were 2 (8%) hospital deaths, unrelated to cryoablation, due to low cardiac output syndrome. There were no intraoperative complications related to cryoablation. Seven (28%) patients required pace-maker implantation due to post-operative atrioventricular block. All patients were discharged on oral antiarrhythmic and anticoagulantion for 6 months. After a median follow-up of 14 months (IQR 7–27) no late mortality was observed. At follow-up, 16/23 (69%) patients are in stable sinus rhythm, 12 without anti-arrhythmic therapy. Two (8.6%) patients had relapse of arrhythmia. Freedom from arrhythmia was 90.9% and cumulative risk of recurrence was 9.6%.Conclusions: Intraoperative cryoablation is safe and effective procedure. Surgical treatment of arrhythmias should always be considered in ACHD, whenever further open-heart repair is needed.

Successful surgical epicardial cryoablation of refractory atrial tachycardia in a patient with repaired tetralogy of Fallot after multiple failed endocardial ablations

“…However, nowadays, cryoprobe is frequently used to serve the same purpose with a better safety profile. 11 …”

Atrial Fibrillation Ablation in Congenital Heart Disease: Therapeutic Challenges and Future Perspectives

“… 38 , 39 , 40 Especially in complex anatomic cases (eg, patients with atrial patch/baffles or an occlusion device in the atrial septum), radiofrequency‐assisted transseptal perforation has emerged as a valuable option for permitting left atrial access and ablation. 41 Less evidence is available on the outcomes of AF cryoablation in ACHD, 42 , 43 , 44 , 45 despite the fact that cryoablation has been shown as noninferior to radiofrequency ablation in individuals with normally structured hearts. 46 According to the experience by Krause et al, 44 cryoablation plus an additional radiofrequency ablation of atrial tachycardia led to promising success rates without major complications (84% success, including 1 redo procedure).…”

“…Another recent study suggests that intraoperative use of cryoablation in AF or intra‐atrial reentrant tachycardia can also be feasible and safe, having no intraoperative complications and promising midterm results. 45 …”