Catheter Ablation and Device Therapy in Congenital Heart Disease

2013 ◽  
pp. 203-214
Author(s):  
Chenni S. Sriram ◽  
Malini Madhavan ◽  
Peter A. Brady ◽  
Bryan C. Cannon ◽  
Christopher J. McLeod ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Catheter Ablation ◽  
Congenital Heart ◽  
Surgical Techniques ◽  
Cardiac Anatomy ◽  
Anatomic Variations ◽  
Device Management ◽  
Surgical History ◽  
Major Increase

Arrhythmias in adult CHD patients represent the leading cause of morbidity and hospitalization, resulting in a major increase in ablation and device-related procedures in these patients. These procedures are often complex, not only because of underlying congenital anatomic variations but also because of the effects of prior surgical repair that can modify the arrhythmic substrate leading to an increased likelihood of multiple types of arrhythmias, even in the same patient. To optimize both success and safety with these procedures, the electrophysiologist must be thoroughly familiar with the underlying cardiac anatomy, prior cardiac surgical history, and known variants of both the pathology and surgical techniques. The purpose of this chapter is to outline the salient concepts and principles pertinent to arrhythmia and device management in patients with CHD.

scholarly journals Anatomical Substrates and Ablation of Reentrant Atrial and Ventricular Tachycardias in Repaired Congenital Heart Disease

2016 ◽  
Vol 5 (2) ◽  
pp. 150 ◽  
Author(s):  
Charlotte Brouwer ◽  
Mark G Hazekamp ◽  
Katja Zeppenfeld ◽  
◽  
◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Catheter Ablation ◽  
Congenital Heart ◽  
Therapeutic Option ◽  
Surgical Techniques ◽  
Technical Developments ◽  
Myocardial Remodelling ◽  
Ventricular Tachycardias ◽  
Repair Techniques

Advances in surgical repair techniques for various types of congenital heart disease have improved survival into adulthood over the past decades, thus exposing these patients to a high risk of atrial and ventricular arrhythmias later in life. These arrhythmias arise from complex arrhythmogenic substrates. Substrate formation may depend on both pathological myocardial remodelling and variable anatomical boundaries, determined by the type and timing of prior corrective surgery. Accordingly, arrhythmogenic substrates after repair have changed as a result of evolving surgical techniques. Radiofrequency catheter ablation offers an important therapeutic option but remains challenging due to the variable anatomy, surgically created obstacles and the complex arrhythmogenic substrates. Recent technical developments including electroanatomical mapping and image integration for delineating the anatomy facilitate complex catheter ablation procedures. The purpose of this review is to provide an update on the changing anatomical arrhythmogenic substrates and their potential impact on catheter ablation in patients with repaired congenital heart disease and tachyarrhythmias.

Ablation of Arrhythmias in Patients with Adult Congenital Heart Disease

2014 ◽  
Vol 3 (1) ◽  
pp. 36-39
Author(s):  
Rodrigo Gallardo Lobo ◽  
Michael Griffith ◽  
Joseph De Bono
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Catheter Ablation ◽  
Congenital Heart ◽  
Therapeutic Option ◽  
Adult Congenital Heart Disease ◽  
Surgical Techniques ◽  
Navigation Systems ◽  
Success Rates ◽  
3D Navigation

Arrhythmias in adults with congenital heart disease, most commonly related to previous surgical procedures, are a frequent comorbidity in this growing population thanks to the improved outcome of surgical techniques. Re-entrant circuits around areas of scarring and natural barriers, combined with abnormal haemodynamics and the underlying anatomy, are the most common cause for these arrhythmias. They are often poorly tolerated and medical treatment is frequently inadequate. In recent years, catheter ablation has emerged as a successful therapeutic option. New advanced techniques such as the use of modern three-dimensional (3D) navigation systems have contributed to better understanding of the arrhythmia mechanisms and higher success rates of the ablation procedures. In this article we briefly summarise the characteristics of the most common arrhythmias in this patient population and some key aspects in their treatment by catheter ablation.

scholarly journals Ablation of Atrial Fibrillation in Patients with Congenital Heart Disease

2017 ◽  
Vol 6 (4) ◽  
pp. 191 ◽  
Author(s):  
Marwan M Refaat ◽  
Jad Ballout ◽  
Moussa Mansour ◽  
◽  
◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Catheter Ablation ◽  
Congenital Heart ◽  
Heart Diseases ◽  
Superior Vena ◽  
Vena Cava ◽  
Surgical Techniques ◽  
Ebstein Anomaly ◽  
Increased Risk

With improved surgical techniques and medical management for patients with congenital heart diseases, more patients are living longer and well into adulthood. This improved survival comes with a price of increased morbidity, mainly secondary to increased risk of tachyarrhythmias. One of the major arrhythmias commonly encountered in this subset of cardiac patients is AF. Similar to the general population, the risk of AF increases with advancing age, and is mainly secondary to the abnormal anatomy, abnormal pressure and volume parameters in the hearts of these patients and to the increased scarring and inflammation seen in the left atrium following multiple surgical procedures. Catheter ablation for AF has been shown to be a very effective treatment modality in patients with refractory AF. However, data and guidelines regarding catheter ablation in patients with congenital heart disease are not well established. This review will shed light on the procedural techniques, success rates and complications of AF catheter ablation in patients with different types of CHD, including atrial septal defects, tetralogy of Fallot, persistent left superior vena cava, heterotaxy syndrome and atrial isomerism, and Ebstein anomaly.

Efficacy of catheter ablation for atrial fibrillation in patients with congenital heart disease

EP Europace ◽  
2019 ◽  
Vol 21 (9) ◽  
pp. 1334-1344 ◽  
Author(s):  
Silvia Guarguagli ◽  
Aleksander Kempny ◽  
Ilaria Cazzoli ◽  
Rosaria Barracano ◽  
Michael A Gatzoulis ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Catheter Ablation ◽  
Congenital Heart ◽  
Surgical Techniques ◽  
Early Referral ◽  
Number Of Children ◽  
Tertiary Centre ◽  
Af Recurrence

Abstract Aims Advances in surgical techniques allow an increasing number of children with congenital heart disease (CHD) to reach adulthood. As patients grow older, atrial fibrillation (AF) is evolving into a major clinical concern and can be difficult to manage medically. Primary AF catheter ablation may, therefore, have a role in this setting but few reports have evaluated its efficacy in CHD patients. Methods and results We retrospectively reviewed 58 consecutive patients [median age 51, interquartile range (IQR) 44–63 years, 57% male] with AF (45% paroxysmal) who underwent 122 ablation procedures in our tertiary centre in the last decade. The majority had CHD of moderate or severe complexity (57%, Bethesda Class 2 or 3) with a dilated left atrium (LA) (81%) and/or right atrium (86%). At 1-year from the first ablation, 32.8% of patients remained in sinus rhythm. Multiple procedures were required in 35 (60%) patients. Freedom from AF at 1-year after the 2nd and 3rd ablation was 40.9% and 36.5%, respectively. Multivariable predictors of AF recurrence were underlying anatomic complexity [hazard ratio (HR) in Bethesda 3 1.98, P = 0.006], type of AF (HR for persistent 1.87, P = 0.004), and indexed LA dimensions (HR for cm2/m2 1.06, P = 0.03). Conclusion While ablation may be a valid option for the treatment of AF in CHD patients, multiple procedures are likely to be required. Early referral and careful patient selection are essential to optimize the results of AF ablation, achieving a low rate of recurrence. Further studies are needed to validate our prognostic model and guide clinical practice.

scholarly journals Ablation of Arrhythmias in Patients with Adult Congenital Heart Disease

2011 ◽  
Vol 3 (1) ◽  
pp. 36 ◽  
Author(s):  
Rodrigo Gallardo Lobo ◽  
Michael Griffith ◽  
Joseph De Bono ◽  
◽  
◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Catheter Ablation ◽  
Congenital Heart ◽  
Therapeutic Option ◽  
Adult Congenital Heart Disease ◽  
Surgical Techniques ◽  
Navigation Systems ◽  
Success Rates ◽  
3D Navigation

Arrhythmias in adults with congenital heart disease, most commonly related to previous surgical procedures, are a frequent comorbidity in this growing population thanks to the improved outcome of surgical techniques. Re-entrant circuits around areas of scarring and natural barriers, combined with abnormal haemodynamics and the underlying anatomy, are the most common cause for these arrhythmias. They are often poorly tolerated and medical treatment is frequently inadequate. In recent years, catheter ablation has emerged as a successful therapeutic option. New advanced techniques such as the use of modern three-dimensional (3D) navigation systems have contributed to better understanding of the arrhythmia mechanisms and higher success rates of the ablation procedures. In this article we briefly summarise the characteristics of the most common arrhythmias in this patient population and some key aspects in their treatment by catheter ablation.

scholarly journals Catheter ablation in adults with congenital heart disease: a 15-year perspective from a tertiary center

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
V Waldmann ◽  
D Amet ◽  
A Zhao ◽  
M Ladouceur ◽  
C Karsenty ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Catheter Ablation ◽  
Success Rate ◽  
Contact Force ◽  
Congenital Heart ◽  
3D Mapping ◽  
Density Mapping ◽  
Tertiary Center ◽  
Procedural Success

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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