Long-term outcome after ablative therapy of postoperative atrial tachyarrhythmia in patients with congenital heart disease and characteristics of atrial tachyarrhythmia recurrences
Abstract
BACKGROUND: Catheter ablation has evolved as a possible curative treatment modality for atrial tachyarrhythmia (AT) in patients with congenital heart defects (CHD). However, data on long-term outcome are scarce. We examined characteristics of recurrent AT after ablation of postoperative AT during long-term follow-up in CHD patients. METHODS AND RESULTS: CHD patients (n=53; 27 men; age, 38+/-15 years) referred for catheter ablation of AT were studied during a follow-up period of 5+/-3 years. After ablative therapy of the first AT (n=53, 27 atrial flutter, cycle length=288+/-81 ms; 22 intra-atrial reentrant tachycardia, cycle length=309+/-81 ms; 5 focal atrial tachycardia, cycle length=380+/-147 ms; success rate, 65%), AT recurred (59% within the first year) in 29 patients; 15 underwent repetitive ablative therapy. Mechanisms underlying recurrent AT were similar in 7 patients (intra-atrial reentrant tachycardia, 2; atrial flutter, 5). The location of arrhythmogenic substrates of recurrent AT (intra-atrial reentrant tachycardia, focal atrial tachycardia) was different for all but 1 patient. After 5+/-3 years, 5 patients died of heart failure, 3 were lost to follow-up, and the remaining patients had sinus rhythm (n=31), AT (n=5), or atrial flutter (n=14). Antiarrhythmic drugs were used by 18 (57%) sinus rhythm patients. CONCLUSIONS: Successive postoperative AT in CHD patients developing over time may be caused by different mechanisms, including focal and reentrant mechanisms. Recurrent AT originated from different locations, suggesting that these new AT were not caused by arrhythmogenicity of previous ablative lesions. Long-term outcome is often complicated by development of atrial fibrillation. Despite frequent need for repeat ablative therapy, most patients are in sinus rhythm.
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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 [362]
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 [362]
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- Authors
- de Groot, N. M. S., Atary, J. Z., Blom, N. A., & Schalij, M. J.
- Affiliations
- From the Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
- Leiden University Medical Center (NL)
- Venue
- Circulation Arrhythmia and Electrophysiology
- Published
- 2010-04
- Volume
- 3
- Issue
- 2
- Pages
- 148-154
- ISSN
- 1941-3084 (ISSN-L)
- 1941-3149
- OpenAlex
- W1994766630
- Cited by
- 108
- References
- 38
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 4 · 2023: 6 · 2022: 5 · 2021: 8 · 2020: 5 · 2019: 6 · 2018: 10 · 2017: 12 · 2016: 10 · 2015: 12 · 2014: 9 · 2013: 7 · 2012: 8
- FWCI
- 3.73
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation Arrhythmia and Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Leiden Repository (Leiden University) (submittedVersion)
- Pure Amsterdam UMC (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
- congenital heart disease, catheter ablation, atrial flutter, intra-atrial reentrant tachycardia, focal atrial tachycardia, arrhythmia recurrence, long-term outcomes, repeat ablation, atrial fibrillation, antiarrhythmic drugs, heart failure mortality
- MeSH terms
- Adult, Atrial Flutter, Female, Follow-Up Studies, Heart Defects, Congenital, Humans, Male, Middle Aged, Postoperative Complications, Tachycardia, Atrioventricular Nodal Reentry, Tachycardia, Ectopic Atrial, Cohort Studies, Catheter Ablation, Retreatment, Secondary Prevention, Young Adult
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