Electrophysiologic Characteristics of Atrial Tachycardia Recurrence: Relevance to Catheter Ablation Strategies in Adults with Congenital Heart Disease

Heart Rhythm ◽  
2021 ◽  
Author(s):  
Jeremy P. Moore ◽  
Austin Burrows ◽  
Roberto G. Gallotti ◽  
Kevin M. Shannon
2019 ◽  
Vol 5 (4) ◽  
pp. 438-447 ◽  
Author(s):  
Christopher S. Grubb ◽  
Matthew Lewis ◽  
William Whang ◽  
Angelo Biviano ◽  
Kathleen Hickey ◽  
...  

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
A El-Medany ◽  
N Sunderland ◽  
R Dobson ◽  
A Nisbet

Abstract Funding Acknowledgements Type of funding sources: None. Background Heart rhythm disorders are an important cause of morbidity and emergency hospitalisation in patients with adult congenital heart disease (ACHD), and this is due to a combination of surgical scar, residual haemodynamic lesions, and cardiac chamber dilatation. The most effective available treatment is catheter ablation, although this can be extremely challenging owing to abnormal anatomy and problems accessing intra cardiac sites critical to the arrhythmia mechanism. However, outcomes of catheter ablation and analysis of factors which may predict recurrence of arrhythmia remain poorly defined.  Purpose  To define the cohort of ACHD patients undergoing catheter ablation for atrial arrhythmia in a large tertiary centre, characterise outcomes, and determine factors associated with arrhythmia recurrence. Methods Retrospective study of all catheter ablations for atrial arrhythmias in ACHD patients between April 13, 2016 and December 16, 2019 at our institution.  Patients were identified using a field search through a centralised database; and pre-specified clinical and procedural data of interest, and time from ablation to recurrence were determined from the computerised electronic record. Binary logistical regression and cox regression analysis were used to determine potential predictors of acute procedural success and arrhythmia recurrence respectively.  Results Among 90 patients (mean age 43 ± 15 years) who underwent catheter ablation for atrial arrhythmia, 39 (43%) were treated for macro-reentrant atrial tachycardia, 19 (21%) for focal atrial tachycardia, 9 (10%) for multifocal atrial tachycardia, 10 (10%) for atrial fibrillation, 7 (8%) for atrioventricular nodal reentrant tachycardia, and 6 (7%) for atrioventricular reentrant tachycardia. 35 (39%) of patients had "severe" complexity ACHD as per the Bethesda classification. 35 (39%) experienced recurrent arrhythmia with a median time to recurrence of 120 days. Age, gender, body mass index, complexity of congenital heart disease, and previous surgical repair were not identified as being significantly associated with recurrence, however univariate cox regression analysis showed a significantly longer time to recurrence in cases utilising electroanatomical mapping and demonstrating non-inducibility of arrhythmia in the lab post ablation (p < 0.001). There was 1 case of post-ablation bradycardia requiring pacemaker implantation, but no other complications. Conclusion Catheter ablation for atrial arrhythmia in ACHD patients is safe and effective, with a majority of patients achieving multiple arrhythmia-free months. Non-inducibility of arrhythmia post procedure and use of electroanatomical mapping are predictors of freedom from recurrence of atrial arrhythmia, suggesting effective characterisation and ablation of the arrhythmia mechanism is more important than the underlying substrate. These findings may aid management decisions for recurrent arrhythmia in ACHD patients.


Heart Rhythm ◽  
2005 ◽  
Vol 2 (7) ◽  
pp. 700-705 ◽  
Author(s):  
John K. Triedman ◽  
Janet M. DeLucca ◽  
Mark E. Alexander ◽  
Charles I. Berul ◽  
Frank Cecchin ◽  
...  

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
V Waldmann ◽  
D Amet ◽  
A Zhao ◽  
M Ladouceur ◽  
C Karsenty ◽  
...  

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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