Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Recurrence rates of atrial arrhythmias after catheter ablation in patients with congenital heart disease (CHD) remain substantial. Given the high prevalence of peritricuspid flutter, systematic cavotricuspid isthmus (CTI) ablation may represent a rational preventive strategy. OBJECTIVES: The objective of this study was to assess the impact of empirical CTI ablation in CHD patients. METHODS: This prospective nationwide study included all CHD patients referred for a first catheter ablation of an atrial arrhythmia between 2020 and 2024. Empirical ablation comprised probabilistic (noninducible arrhythmia with prior documentation) and prophylactic (no prior documentation) ablation. The primary endpoint was freedom from any atrial arrhythmia recurrence. Secondary endpoints included arrhythmia-related hospitalizations, redo ablations, and complications. RESULTS: Among 575 patients undergoing a first catheter ablation for atrial arrhythmia, 345 (60.0%) had CTI-dependent flutter. The remaining 230 patients formed the study population (mean age: 48.2 ± 16.4 years; 50.9% male). CHD complexity was predominantly moderate (57.4%). Targeted arrhythmias were atrial macro-re-entry (53.0%), atrial fibrillation (47.0%), and focal atrial tachycardia (17.4%), with multiple arrhythmias in 16.5%. Empirical CTI ablation was performed in 71 patients (30.9%) and was associated with significantly higher freedom from any atrial arrhythmia at 1 year (78.1% vs 65.6%, P = 0.010) and 2 years (71.2% vs 56.1%, P = 0.025), remaining independently associated with lower risk of recurrence after multivariable adjustment (HR: 0.47, 95% CI: 0.24-0.92, P = 0.027). This benefit was primarily observed in patients without atrial fibrillation history (interaction P = 0.005). Arrhythmia-related hospitalization was also significantly reduced (14.1% vs 25.8%, P = 0.048). CONCLUSIONS: Empirical CTI ablation is associated with improved freedom from atrial arrhythmia and reduced rehospitalization in CHD patients.
Source: JACC. Clinical electrophysiology
Authors: Geoffroy Ditac, Francis Bessière, Guillaume Duthoit, Jean-Luc Pasquié, Laure Champ-Rigot, Mathieu Albertini, Frédéric Anselme, Stefano Bartoletti, Damien Bonnet, Charlène Bredy, Sok-Sithikun Bun, Gaël Clerici, Antoine Da Costa, Christian De Chillou, Pascal Defaye, Maxime de Guillebon, Clément Davril, Antoine Delinière, Nicolas Derval, Nabil Dib, Luca Donisi, Kevin Gardey, Caroline Ghanimé, Jean-Baptiste Gourraud, Sébastien Hascoët, Néfissa Hammache, Roland Henaine, Laurence Iserin, Peggy Jacon, François Jourda, Clément Karsenty, Paul Khairy, Linda Koutbi, Gabriel Laurent, Baptiste Maille, Alice Maltret, Jacques Mansourati, Nathan Marimpouy, Raphaël Martins, Philippe Maury, Antoine Milhem, Pamela Moceri, Pierre Ollitrault, Pauline Pinon, Olivier Piot, Karim Benali, Kahina Racelma, Robin Richard-Vitton, Frédéric Sacher, Frédéric Sebag, Marine Tortigue, Sandrine Venier, Marie Wilkin, Pierre-François Winum, Eloi Marijon, Nicolas Combes, Victor Waldmann
Institutions: Lyon 1 Université, Inserm, Hospices Civils de Lyon, Hôpital Louis Pradel, Laboratoire des applications Thérapeutiques des Ultrasons, Assistance Publique – Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Centre National de la Recherche Scientifique, Université de Montpellier, Physiologie et Médecine Expérimentale du Coeur et des Muscles, Centre Hospitalier Universitaire de Montpellier, Centre Hospitalier Universitaire de Caen Normandie, Université Paris Cité, Hôpital Européen Georges-Pompidou, Paris Cardiovascular Research Center, Centre Hospitalier Universitaire de Rouen, Hôpital Marie Lannelongue, Hôpital Necker-Enfants Malades, Institut des Maladies Génétiques Imagine, Centre Hospitalier Universitaire de Nice, Centre Hospitalier Universitaire de La Réunion, Centre Hospitalier Universitaire de Saint-Étienne, Centre Hospitalier Régional et Universitaire de Nancy, Centre Hospitalier Universitaire de Grenoble, Centre Hospitalier De Pau, Mécanismes en sciences intégratives du vivant, Université de Bordeaux, Centre Hospitalier Universitaire de Bordeaux, CHU Dijon Bourgogne, Centre Hospitalier Universitaire de Nantes, Nantes Université, Université Paris-Saclay, Bicêtre Hospital, Centre Hospitalier Universitaire de Toulouse, Montreal Heart Institute, Université de Montréal, Hôpital de la Timone, Centre Hospitalier Régional Universitaire de Brest, Centre Hospitalier Universitaire de Rennes, Centre Hospitalier de La Rochelle, Centre Cardiologique du Nord, Institute Mutualiste Montsouris, Centre Hospitalier Universitaire de Nîmes, Clinique Pasteur
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $5,000
OpenAlex ID: W7208756542