Background: Catheter ablation for supraventricular tachycardia (SVT) in adults with congenital heart disease (ACHD) is an important therapeutic option. Cavotricuspid isthmus (CTI) dependent intra-atrial re-entrant tachycardia (IART) is common. However, induction of sustained tachycardia at the time of ablation is not always possible. We hypothesised that performing an empiric CTI line in case of noninducibility leads to good outcomes.Objectives: Long-term outcomes of empiric versus entrained CTI ablation in CHD patients were examined.Methods: Retrospective, single-centre, case-control study over seven years.Arrhythmia free survival post empiric versus entrained CTI ablation were compared.Results: 87 CTI ablations were performed in 85 ACHD patients between 2010 and 2017. The mean age of the cohort was 43 years and 48% were men. Underlying etiology included ASD (31%), VSD (11.4%), AVSD (9.1%), AVR (4.8%), Fallot's tetralogy (18.4%), Ebstein's anomaly (2.3%), Fontan surgery (9.2%) and Mustard/Senning repair (13.8%). CTI dependent IART was entrained in 59 patients whereas it was non-inducible in 28. The latter had an empiric CTI-line ablation. 57% of procedures were performed without a general anaesthetic. There were no procedural complications. There was no significant difference in the mean procedure and fluoroscopy times between the groups (Empiric vs Entrained CTI; 169.1 vs 183.3 and 28.1 vs 19.9 min). After a mean follow-up of 21 months, arrhythmia-free survival was 64.3% versus 72.8% (p-value 0.44) in the empiric and entrained CTI groups. Conclusion:Long-term outcomes after empiric and entrained CTI line ablation for IART ACHD patients are comparable. This is a safe and effective therapeutic option.In the case of non-inducibility of IART, an empiric CTI line ablation should be performed in this cohort.
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