Catheter Ablation for Atrial Tachycardia in Adults With Congenital Heart Disease: Electrophysiological Predictors of Acute Procedural Success and Post-Procedure Atrial Tachycardia Recurrence

Christopher S Grubb; Matthew Lewis; William Whang; Angelo Biviano; Kathleen Hickey; Marlon Rosenbaum; Hasan Garan

doi:10.1016/j.jacep.2018.10.011

Catheter Ablation for Atrial Tachycardia in Adults With Congenital Heart Disease: Electrophysiological Predictors of Acute Procedural Success and Post-Procedure Atrial Tachycardia Recurrence

JACC Clin Electrophysiol. 2019 Apr;5(4):438-447. doi: 10.1016/j.jacep.2018.10.011. Epub 2019 Jan 30.

Authors

Christopher S Grubb¹, Matthew Lewis², William Whang³, Angelo Biviano¹, Kathleen Hickey¹, Marlon Rosenbaum², Hasan Garan⁴

Affiliations

¹ Cardiac Electrophysiology Unit, Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York.
² Division of Cardiology, Department of Medicine, Schneeweiss Adult Congenital Heart Center, Columbia University Medical Center, New York, New York.
³ Helmsley Center for Electrophysiology, Division of Cardiology, Mount Sinai Health System, New York, New York.
⁴ Cardiac Electrophysiology Unit, Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York. Electronic address: Hg2017@cumc.columbia.edu.

PMID: 31000097
DOI: 10.1016/j.jacep.2018.10.011

Abstract

Objectives: This study sought to determine the electrophysiological predictors of acute procedural success and of post-ablation recurrence of atrial tachyarrhythmias (ATs) in our adult congenital heart disease (ACHD) population undergoing catheter ablation for treatment of AT.

Background: Catheter ablation is frequently performed to treat persistent AT in ACHD. The predictors of post-ablation AT recurrence have not been well studied in the ACHD population.

Methods: The authors performed a retrospective study of all catheter ablations for treatment of AT performed in ACHD patients between December 1, 2005, and July 20, 2017, at Columbia University Medical Center. Pre-specified clinical and procedural data of interest and the time from ablation to recurrence were determined by chart and procedure report review.

Results: A total of 140 patients (mean age: 45 years) underwent catheter ablation for 182 AT. Of the AT, 179 (93%) were intra-atrial macro-re-entrant tachycardia, and 12 (7%) had a focal origin. The presence of a single mechanism was a predictor of acute procedural success that could be achieved in 89% of the patients. At a median of 49.9 months, 62 patients (44%) had recurrent AT. Time to recurrence was significantly shorter (12.5 months) for recurrent AT in 13 of the 20 patients with previous Fontan procedure. By multivariable analysis, acute procedural success was a positive predictor and prior surgical maze procedure was a negative predictor of AT-free survival. Of the 62 patients with recurrent AT, 42 (68%) had a second catheter ablation procedure, and in 22 of these, the AT mechanism was different than previously observed.

Conclusions: Catheter ablation for AT in ACHD patients is an effective method of arrhythmia control. More than 1 AT mechanism per patient is common. Acute procedural success is a predictor of freedom from AT recurrence. The majority of patients achieve multiple arrhythmia-free years.

Keywords: adult congenital heart disease; atrial arrhythmias; catheter ablation; outcomes.

MeSH terms

Adult
Catheter Ablation*
Electrocardiography
Female
Heart Defects, Congenital* / complications
Heart Defects, Congenital* / physiopathology
Humans
Male
Middle Aged
Recurrence
Retrospective Studies
Tachycardia* / etiology
Tachycardia* / mortality
Tachycardia* / physiopathology
Tachycardia* / surgery
Treatment Outcome