High density mapping and catheter ablation of atrial tachycardias in adults with congenital heart disease

Abstract Background With the growing population of adults with congenital heart disease (ACHD), the number of catheter ablation procedures is expected to increase over time. Purpose We aimed to describe temporal trends in volume and outcomes of catheter ablation procedures in ACHD patients in a large tertiary center. Methods Retrospective observational study including all consecutive ACHD patients undergoing catheter ablation in a tertiary reference center over a 15-year period. Acute procedural success rate (including complete success in case of non-inducibility of any arrhythmia at the end of the procedure) as well as freedom from recurrence at 12 months were analyzed. Results From November 2004 to November 2019, 302 catheter ablations in 221 ACHD patients (43.6±15.0 years, 58.9% males) were performed. The annual number of catheter ablation increased progressively from 4 to 60 by year (p<0.001). Intra-atrial reentrant tachycardia/focal atrial tachycardia was the most common targeted arrhythmia (n=217, 71.9%). Over the study period, acute procedural success rate increased from 45.0% to 93.3% (p<0.001), including complete acute procedural success from 45.0% to 88.1% (p<0.001) (Figure 1). The use of irrigated catheters (30.0% to 94.8%, p<0.001), 3D-mapping systems (60.0% to 96.3%, p<0.001), contact force catheters (0.0% to 91.9%, <0.001), and high-density mapping (0.0% to 71.9%, p<0.01) increased significantly. Use of irrigated catheters (OR=3.96, 95% CI: 1.79–8.55), 3D-mapping system (OR=3.55, 95% CI: 1.62–7.55), contact force catheters (OR=3.46, 95% CI: 1.71–7.25), and high-density mapping (OR=3.85, 95% CI: 1.60–7.26) were associated with acute procedural success. The rate of freedom from any recurrence at 12 months increased from 29.4% to 66.2% (p=0.001). Seven (2.3%) non-fatal complications occurred. Conclusions The number of catheter ablation procedures in ACHD patients has considerably increased over the last 15 years. Advances in ablative technologies appear to be associated with a low rate of complications and a significant improvement in acute and midterm outcomes. Evolution of acute procedural success Funding Acknowledgement Type of funding source: None

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An initial experience of high-density mapping-guided ablation in a cohort of patients with adult congenital heart disease

EP Europace ◽

10.1093/europace/euy188 ◽

2019 ◽

Vol 21 (Supplement_1) ◽

pp. i43-i53 ◽

Cited By ~ 8

Author(s):

Sabine Ernst ◽

Ilaria Cazzoli ◽

Silvia Guarguagli

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Congenital Heart ◽

Adult Congenital Heart Disease ◽

High Density ◽

Initial Experience ◽

Density Mapping ◽

Adult Congenital

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Characterization of the Mechanism and Substrate of Atrial Tachycardia Using Ultra‐High‐Density Mapping in Adults With Congenital Heart Disease: Impact on Clinical Outcomes

Journal of the American Heart Association ◽

10.1161/jaha.118.010535 ◽

2019 ◽

Vol 8 (4) ◽

Cited By ~ 7

Author(s):

Lilian Mantziari ◽

Charles Butcher ◽

Rui Shi ◽

Andrianos Kontogeorgis ◽

Aaisha Opel ◽

...

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Clinical Outcomes ◽

Atrial Tachycardia ◽

Congenital Heart ◽

High Density ◽

Density Mapping ◽

Disease Impact

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Electrophysiological Characteristics of Intra‐Atrial Reentrant Tachycardia in Adult Congenital Heart Disease: Implications for Catheter Ablation

Journal of the American Heart Association ◽

10.1161/jaha.121.020835 ◽

2021 ◽

Author(s):

Ann‐Kathrin Kahle ◽

Roberto G. Gallotti ◽

Fares‐Alexander Alken ◽

Christian Meyer ◽

Jeremy P. Moore

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Congenital Heart ◽

Adult Congenital Heart Disease ◽

Conduction Block ◽

High Density ◽

Conduction Time ◽

Reentrant Tachycardia ◽

Density Mapping ◽

Pathway Length

Background Ultra‐high‐density mapping enables detailed mechanistic analysis of atrial reentrant tachycardia but has yet to be used to assess circuit conduction velocity (CV) patterns in adults with congenital heart disease. Methods and Results Circuit pathways and central isthmus CVs were calculated from consecutive ultra‐high‐density isochronal maps at 2 tertiary centers over a 3‐year period. Circuits using anatomic versus surgical obstacles were considered separately and pathway length <50th percentile identified small circuits. CV analysis was used to derive a novel index for prediction of postablation conduction block. A total of 136 supraventricular tachycardias were studied (60% intra‐atrial reentrant, 14% multiple loop). Circuits with anatomic versus surgical obstacles featured longer pathway length (119 mm; interquartile range [IQR], 80–150 versus 78 mm; IQR, 63–95; P <0.001), faster central isthmus CV (0.1 m/s; IQR, 0.06–0.25 versus 0.07 m/s; IQR, 0.05–0.10; P =0.016), faster non‐isthmus CV (0.52 m/s; IQR, 0.33–0.71 versus 0.38 m/s; IQR, 0.27–0.46; P =0.009), and fewer slow isochrones (4; IQR, 2.3–6.8 versus 6; IQR 5–7; P =0.008). Both central isthmus ( R 2 =0.45; P <0.001) and non‐isthmus CV ( R 2 =0.71; P <0.001) correlated with pathway length, whereas central isthmus CV <0.15 m/s was ubiquitous for small circuits. Non‐isthmus CV in tachycardia correlated with CV during block validation ( R 2 =0.94; P <0.001) and a validation map to tachycardia conduction time ratio >85% predicted isthmus block in all cases. Over >1 year of follow‐up, arrhythmia‐free survival was better for homogeneous CV patterns (90% versus 57%; P =0.04). Conclusions Ultra‐high‐density mapping‐guided CV analysis distinguishes atrial reentrant patterns in adults with congenital heart disease with surgical obstacles producing slower and smaller circuits. Very slow central isthmus CV may be essential for atrial tachycardia maintenance in small circuits, and non‐isthmus conduction time in tachycardia appears to be useful for rapid assessment of postablation conduction block.

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