530Atrial tachyarrhythmias in adult congenital heart disease: predictors and rates of recurrence after catheter ablation
Year: 2018
Type: conference-abstract
Abstract: Background: Adult congenital heart disease (ACHD) patients often have persistent, drug refractory atrial tachyarrhythmias (AT) causing significant morbidity and mortality requiring treatment with catheter ablation. We sought to identify predictors and rates of recurrence in the ACHD population undergoing catheter ablation. Methods: This is a single center, retrospective study of patients with ACHD undergoing catheter ablation for documented AT. Between 12/1/2005 and 7/20/2017, 140 ACHD patients underwent catheter ablation. Baseline characteristics were obtained from the medical records and information regarding the tachycardias was obtained directly from procedure reports. Results: Among the 140 patients undergoing ablation 51% were male with an average age of 45.9±1.2 years. All patients had surgically corrected ACHD. Fontan physiology was present in 9% of patients. In the cardiac electrophysiology laboratory, baseline cardiac rhythm was AT in 93 patients. In all 47 patients not presenting in AT programmed cardiac stimulation (PCS) induced AT. After catheter mapping and ablation 36 patients had additional, distinct AT mechanisms induced either via PCS (42%) or spontaneous transformation during ablation (58%). In total 182 distinct AT mechanisms were ablated in 140 patients. Of these 182 mechanisms, 93% were macroreentry and 7% were focal ATs. Of the 170 macrorentrant ATs, 55% were typical atrial flutter and ablated at cavotricuspid isthmus while 45% had other mechanisms. Acute success defined as lack of further inducible sustained AT was achieved in 89% of cases. Recurrence occurred in 62 of the 140 patients. Mean time to recurrence was 19.1±2.8 months. Significant predictors of time to recurrence included Fontan physiology (HR: 2.138; p=.015), lack of acute success during the first ablation (HR:2.35; p=.019), history of a surgical MAZE procedure (HR:4.885; p=.007), and taking amiodarone when presenting for initial ablation (HR:2.104; p=.015). A second catheter ablation was performed in 42 patients. 57 AT mechanisms were mapped and ablated during second procedures. 22 patients had only new, distinct AT mechanisms not seen in the first ablation. 20 patients had the same or similar mechanisms identified in the previous ablation. 8 patients required 3 and 2 patients required 4 ablations. A single patient required 5. Conclusion: The majority of patients with surgically corrected ACHD and AT live multiple arrhythmia free years following catheter ablation, but recurrence occurs in a substantial minority. Predictors of increased risk of recurrence include Fontan physiology, inducibility of AT at the end of ablation, and failure of other treatment modalities such as surgical MAZE and amiodarone.
Source: EP Europace
Authors: C S Grubb, M Lewis, M Rosenbaum, A Biviano, H Garan
Institution: Columbia University Irving Medical Center
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2792061085