Ventricular Tachycardia Ablation in Adult Congenital Heart Disease

Abstract

Patients with congenital heart disease (CHD) are at risk for late ventricular tachycardia (VT) and sudden cardiac death. Slow conducting anatomical isthmuses, bordered by unexcitable tissue created by valve annuli, ventricular incisions, and prosthetic material are the dominant substrate for macroreentrant monomorphic VTs in repaired CHD. These well-defined substrates allow for catheter or surgical transection with clear endpoints. This review elaborates on VT substrates in various CHD, and evolving mapping and ablation approaches. Because most research is conducted in patients with repaired tetralogy of Fallot, this malformation will serve as a paradigm.

Keywords: Catheter ablation; Congenital heart disease; Electroanatomical mapping; Surgical ablation; Tetralogy of Fallot; Ventricular tachycardia.