Repeat radiofrequency catheter ablation of atrial tachycardias in patients with congenital heart disease

Abstract

Introduction Atrial tachycardias (AT) in patients with congenital heart disease (CHD) are significantly contributing to morbidity and mortality. Aim of this study was to evaluate the long‐term course of CHD patients requiring repeat ablation procedures (RAP) of AT. Patients and Methods All 144 patients with CHD who had undergone ablation of AT at our center between January 2003 and October 2018 were enrolled. Patients were classified according to the complexity of CHD: complex CHD (cCHD), moderate CHD (mCHD), and simple CHD (sCHD). Results A total of 101 RAP were performed in 64 patients. One RAP was performed in n = 40, two in n = 13, three in n = 10, and five in n = 1. Acute success rate was 82% (83/101) and was not associated with the complexity of CHD (p = 1.0). Number of procedures was lower in patients with sCHD than in patients with mCHD and cCHD (sCHD 1.3 ± 0.6, mCHD 1.8 ± 1.0, and cCHD 1.8 ± 1.1, p = .04). RAP were most frequent in patients after Fontan palliation or Atrial switch procedure (2.0 ± 1.1 [n = 41] vs. 1.6 ± 0.9 all others, p = .016) and in patients with multiple unstable AT's (2.5 ± 1.1 [n = 11] vs. 1.7 ± 1.0, p = .008). Major complications occurred in 4/101 procedures. Complete follow‐up was available in 125 patients. Since last RAP 73% of the patients were in sinus/atrial rhythm and 34/125 patients (27%) with AT recurrence did not require re‐ablation with mean follow‐up of 52 ± 40 months. Conclusions Recurrences after ablation of AT in CHD patients were frequent. After RAP promising long‐term results could be achieved. Data encourage repetitive ablation procedures in this patient population.

Coherent mapping of atrial tachycardias in patients with congenital heart disease

“… 17 Especially in patients after atrial switch—or Fontan procedure (55% of patients in the Coherence group) multiple re-procedures might be necessary also after initially successful ablations. 4 As described before, almost half of the patients with recurrences did not require further catheter ablation until the end of follow-up. Final scar formation and additional antiarrhythmic therapy may lead to sinus rhythm/atrial paced rhythm even after early recurrence.…”

“…Final scar formation and additional antiarrhythmic therapy may lead to sinus rhythm/atrial paced rhythm even after early recurrence. 4 , 18 Complication rate was low and no complications related to the PENTARAY™ catheter were observed.…”

“… 2 However, during follow-up, recurrence rates remain high (34–54%) necessitating multiple repeat ablation procedures, 1 , 2 especially in patients after an atrial switch procedure for d-transposition of the great arteries or after Fontan procedure. 4 …”

Fate After the Mustard Procedure for d-Transposition of the Great Arteries: Impact of Age, Complexity, and Atrial Tachyarrhythmias: A Single Center Experience

“…Atrial tachycardia with high rate AV conduction leading to ventricular ischemia is the proposed pathophysiology for sudden cardiac death in this unique patient population [ 13 ]. Thus, atrial tachyarrhythmias should be rigorously treated by catheter ablation to reduce risk of stroke and heart failure and to minimize risk for sudden cardiac death realizing that repeat catheter ablation due to tachycardia recurrence or new atrial tachycardias is often required in those individuals [ 14 , 15 ].…”

Advancing the science of management of arrhythmic disease in children and adult congenital heart disease patients within the last 25 years

“…Recurrences and/or new atrial tachycardias are not uncommon, often requiring multiple ablation procedures in order to achieve freedom from tachycardia. 106 , 107 The advent of 3D-EAM systems significantly added to our understanding of tachycardia mechanisms and improved mapping and ablation results, especially in atrial tachycardias (focal or reentrant) other than cavotricuspid isthmus–dependent atrial flutter. A non-contact, multielectrode array system was successfully applied for mapping of atrial tachycardia substrates and for activation mapping in the early era of 3D-EAM in a cohort of subjects with CHD.…”