Long-term outcome of ablative therapy of post-operative atrial tachyarrhythmias in patients with tetralogy of Fallot: a European multi-centre study

Groot, Natasja M.S. de; Schalij, Martin J.; Makowski, Karol; Szili-Török, Tamás; Jordaens, Luc; Nielsen, Jens Cosedis; Jensen, Henrik Kjærulf; Gerdes, Jens Christian; Delacrétaz, Etienne

doi:10.1093/europace/eur313

Cited by 44 publications

(44 citation statements)

References 24 publications

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“…The acute success rate of 74.5% in our series confirms the data published in the literature, with a success rate ranging from 63% to 90%, 14,[31][32][33][34] although definition of success does not always include CTI bidirectional block. [35][36][37][38] Actually, in the largest series where CTI bidirectional block is required to consider ablation as successful, the acute success is lower.…”

Section: Discussionsupporting

confidence: 88%

Predictors of Acute Failure Ablation of Intra‐atrial Re‐entrant Tachycardia in Patients With Congenital Heart Disease: Cardiac Disease, Atypical Flutter, and Previous Atrial Fibrillation

Roca‐Luque

Rivas-Gándara

Dos‐Subirà

et al. 2018

JAHA

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BackgroundIntra‐atrial re‐entrant tachycardia (IART) in patients with congenital heart disease (CHD) increases morbidity and mortality. Radiofrequency catheter ablation has evolved as the first‐line treatment. The aim of this study was to analyze the acute success and to identify predictors of failed IART radiofrequency catheter ablation in CHD.Methods and ResultsThe observational study included all consecutive patients with CHD who underwent a first ablation procedure for IART at a single center from January 2009 to December 2015 (94 patients, 39.4% female, age: 36.55±14.9 years). In the first procedure, 114 IART were ablated (acute success: 74.6%; 1.21±0.41 IART per patient) with an acute success of 74.5%. Cavotricuspid isthmus–related IART was the only arrhythmia in 51%; non–cavotricuspid isthmus–related IART was the only mechanism in 27.7% and 21.3% of the patients had both types of IART. Predictors of acute radiofrequency catheter ablation failure were as follows: nonrelated cavotricuspid isthmus IART (odds ratio 7.3; confidence interval [CI], 1.9–17.9; P=0.04), previous atrial fibrillation (odds ratio 6.1; CI, 1.3–18.4; P=0.02), transposition of great arteries (odds ratio, 4.9; CI, 1.4–17.2; P=0.01) and systemic ventricle dilation (odds ratio 4.8; CI, 1.1–21.7; P=0.04) with an area under the receiver operating characteristic curve of 0.83±0.056 (CI, 0.74–0.93, P=0.001). After a mean follow‐up longer than 3.5 years, 78.3% of the patients were in sinus rhythm (33.1% of the patients required more than 1 radiofrequency catheter ablation procedure).ConclusionsAlthough ablation in CHD is a challenging procedure, acute success of 75% can be achieved in moderate–highly complex CHD patients in a referral center. Predictors of failed ablation are IART different from cavotricuspid isthmus, previous atrial fibrillation, and markers of complex CHD (transposition of great arteries, systemic ventricle dilation).

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Section: Discussionsupporting

confidence: 88%

Predictors of Acute Failure Ablation of Intra‐atrial Re‐entrant Tachycardia in Patients With Congenital Heart Disease: Cardiac Disease, Atypical Flutter, and Previous Atrial Fibrillation

Roca‐Luque

Rivas-Gándara

Dos‐Subirà

et al. 2018

JAHA

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“…Complete or partial control of the arrhythmia can be achieved by surgery or catheter-based haemodynamic revision of the repair in cases who are clinically and haemodynamically ill. 87 Catheter ablation of AT is associated with a high procedural success rate during long-term follow-up in the vast majority of patients. 88 …”

Section: Tetralogy Of Fallotmentioning

confidence: 99%

Supraventricular Arrhythmias in Patients with Adult Congenital Heart Disease

Lundqvist

Potpara

Malmborg

2017

Arrhythmia &Amp; Electrophysiology Review

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Access at: www.AERjournal.comWith the advent of successful surgical repairs and modern diagnostic techniques, an increasing number of patients with congenital heart disease survive to adulthood. Despite these improvements, the surgical corrective atrial incisions performed during childhood lead to subsequent myocardial scarring that have the inherent risk of harbouring substrates for macro-reentrant atrial tachycardias (MRATs). Apart from surgical conduction barriers such as patches, conduits and surgical scars, there are also natural barriers including valve annuli and venous orifices that potentially may become critical substrates for tachyarrhythmias. 1The 20-year risk of developing atrial arrhythmias among patients with adult congenital heart disease (ACHD) was 7 % in a patient aged 20 years and 38 % in a patient aged 50 years in a population-based study. Apart from these tachyarrhythmias, patients with ACHD also have an increased risk of pump failure, stroke and sudden cardiac death (SCD). 6 Although the incidence of SCD is low (0.09 % per year) in the CHD population, it is higher compared with age-matched controls 7 and related to arrhythmias in 14 % of all deaths after initial repair. hearts have the highest risk of SCD (2-9 % per decade). [8][9][10] In the German National Register for Congenital Heart Defects for adult patients, the mortality rate during a median follow-up of 3.7 years was 9.2 % among 2596 patients, with heart failure (27.6 %) and SCD (23.0 %) as the leading causes of death. 11 Deceased patients had a more complex CHD and extracardiac comorbidities.The treatment of CHD imposes certain safety considerations when choosing antiarrhythmic drugs while various cardiac anatomical barriers and required operator expertise should be taken into account when referring patients for catheter ablation. The complex cardiac anatomy and haemodynamic changes require special precautions related to the increased risk of pro-arrhythmia when using antiarrhythmic drugs and the need for specialised expertise and sophisticated mapping systems when complex catheter ablation procedures are performed.Pre-procedural cardiac imaging with a variety of methodologies can assist with venous access to the heart, determining details of native cardiovascular anatomy and the nature of corrective surgery and evaluation of ventricular function. Reviewing all tachycardias from prior ECGs is also important before the procedure. The success rates after catheter ablation in patients with ACHD is somewhat lower compared with the general population, with acute and long-term success rates AbstractAn increasing number of patients with congenital heart disease survive to adulthood; such prolonged survival is related to a rapid evolution of successful surgical repairs and modern diagnostic techniques. Despite these improvements, corrective atrial incisions performed at surgery still lead to subsequent myocardial scarring harbouring a potential substrate for macro-reentrant atrial tachycardia. Macroreentrant atrial tachycardias are the mo...

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“…32 Although less frequent, non-automatic focal atrial tachycardias (FATs) do occur, accounting for 5-10 % of all AT. 29,33,34 These non-automatic…”

Section: Atrial Tachyarrhythmiasmentioning

confidence: 99%

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

Brouwer

Hazekamp

Zeppenfeld

2016

Arrhythmia &Amp; Electrophysiology Review

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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.

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Long-term outcome of ablative therapy of post-operative atrial tachyarrhythmias in patients with tetralogy of Fallot: a European multi-centre study

Cited by 44 publications

References 24 publications

Predictors of Acute Failure Ablation of Intra‐atrial Re‐entrant Tachycardia in Patients With Congenital Heart Disease: Cardiac Disease, Atypical Flutter, and Previous Atrial Fibrillation

Predictors of Acute Failure Ablation of Intra‐atrial Re‐entrant Tachycardia in Patients With Congenital Heart Disease: Cardiac Disease, Atypical Flutter, and Previous Atrial Fibrillation

Supraventricular Arrhythmias in Patients with Adult Congenital Heart Disease

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

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