Outcome of Intra-Atrial Re-Entrant Tachycardia Catheter Ablation in Adults With Congenital Heart Disease
Open accessAbstract
Objectives The aim of this study was to determine the acute and long-term outcome of radiofrequency catheter ablation (RFCA) for intra-atrial re-entrant tachycardia (IART) in adults with congenital heart disease (CHD), and predictors of these outcomes.Background Atrial myopathy can be progressive in CHD and contributes to the substrate for IART. Although the outcome of RFCA for IART has been well described in children and adolescents with CHD, it is unclear whether these results are similar in the adult population.Methods Clinical records of adults with CHD undergoing attempted RFCA of IART were analyzed retrospectively. Multivariate analyses identified clinical and procedural factors that predicted acute and long-term outcomes.Results A total of 193 procedures was performed in 130 patients (mean age 40 ± 13 years); 82 of 118 (69%) initially attempted RFCA were successful, defined as termination of all IART circuits. The use of electroanatomic mapping was associated with a successful RFCA, whereas Fontan palliation and Mustard repair were associated with an unsuccessful RFCA. Median clinical follow-up of 77 patients (≥2 months of follow-up) after a successful RFCA was 3.7 years (range 0.2 to 10.2 years). IART recurrence was noted in 48%, cardioversion/reablation in 42%, and death in 4%. Older age and Fontan palliation were independent predictors of IART recurrence.Conclusions In adults with CHD, acute and long-term outcomes of RFCA for IART are similar to those reported for younger cohorts. Complex atrial surgery limits the success of RFCA, and older age is associated with a higher risk of IART recurrence.
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Catheter ablation of AT or AFL are associated with lower success rates, 65% to 82%, as compared with those in the absence of CHD.
“Catheter ablation of AT or AFL are associated with lower success rates, 65% to 82%, as compared with those in the absence of CHD, 362,363,365 although higher success rates have been achieved with the advent of advanced mapping and ablation techniques.366”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [363]
The acute success rates of catheter ablation procedures of SVT in ACHD patients range from 65 to 100%, with a higher recurrence rate, 20-60% within 2 years, than seen in other cohorts for routine SVT ablation.
“The acute success rates of catheter ablation procedures of SVT in ACHD patients ranges from 65 to 100%, with a higher recurrence rate, 20 -60% within 2 years, than seen in other cohorts for routine SVT ablation.362 -364,379”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [363]
Both Fontan and Mustard repairs have been associated with less successful ablation results as compared to other ACHD anomalies, related to low success rate (54% vs 83% for other CHD) and high recurrence rate (50% vs 32%) after an initial successful ablation procedure.
“Both Fontan and Mustard repairs have been associated with less successful ablation results as compared to other ACHD anomalies, related not only to the low success rate of catheter ablation (54% vs. 83% for other CHD) but also to a high recurrence rate (50% vs. 32%) after an initial successful ablation procedure.363,365”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [363]
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“In this population, therapy with transcatheter ablative techniques frequently is limited due to difficulties accessing the common pulmonary venous atrium (PVA) from the systemic veins.(3,4) Several approaches have been used to access the PVA in these procedures, including retrograde via systemic artery, direct via ste…”
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- Authors
- Yap, S.-C., Harris, L., Silversides, C. K., Downar, E., & Chauhan, V. S.
- Affiliations
- University Health Network (CA)
- Corresponding author
- Chauhan, Vijay S.
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2010-11
- Volume
- 56
- Issue
- 19
- Pages
- 1589-1596
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W5676170
- Cited by
- 136
- References
- 23
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 6 · 2023: 7 · 2022: 8 · 2021: 6 · 2020: 5 · 2019: 9 · 2018: 14 · 2017: 15 · 2016: 17 · 2015: 15 · 2014: 8 · 2013: 15 · 2012: 5
- FWCI
- 4.62
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Keywords
- radiofrequency catheter ablation, congenital heart disease, adults, atrial cardiomyopathy, electroanatomical mapping, Fontan palliation, Mustard repair, atrial tachycardia recurrence, age as risk factor
- MeSH terms
- Adolescent, Adult, Age Factors, Aged, Female, Follow-Up Studies, Heart Atria, Heart Defects, Congenital, Cardiac Surgical Procedures, Humans, Male, Middle Aged, Retrospective Studies, Tachycardia, Atrioventricular Nodal Reentry, Treatment Outcome, Catheter Ablation, Young Adult
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