Catheter ablation in grown-up congenital heart disease patients: A single-center experience

Abstract

Background: Supraventricular and ventricular tachyarrhythmias represent a common complication in grown-up patients with congenital heart defects (CHD) associated with worsening of functional capacity and increased morbidity. The aim of this study was to present the experience of our department on catheter ablation (CA) addressing safety and efficacy concerns.

Methods: Consecutive patients with CHD treated with CA between 2002 and 2021 in our hospital were included in this study. The established ablation techniques modified according to the patient's special anatomic characteristics were applied. NYHA functional status along with the underlying cardiac rhythm were recorded during the follow-up.

Results: In total, 35 patients (44.9 ​± ​2.7 years, 22 males) underwent CA for the management of either supraventricular or ventricular (n ​= ​2) arrhythmia during the study period. The most common anatomical diagnoses were atrial septal defect (13), Tetralogy of Fallot (5) and transposition of great arteries (3). Atrial fibrillation or atrial flutter was the most frequent baseline diagnosis, observed in 15 (42.8%) patients, followed by intra-atrial reentrant tachycardia in 9 (25.7%) patients and atrioventricular nodal reentry tachycardia (AVNRT) in 5 (14.2%). No significant complication occurred during CA. Patients were followed for a median period of 9 years after the index procedure. At this time, arrhythmia recurrence was observed in 13 patients (37,1%) of whom 6 underwent a redo procedure. Furthermore, 4 patients underwent a permanent pacemaker implantation, while 6 were offered an ICD treatment.

Conclusion: CA is a safe method offering significant benefits regarding the management of tachyarrhythmias and preserving functional capacity in adult patients with CHD.

Keywords: Atrial tachycardia; Catheter ablation; Congenital heart disease; Supraventricular arrhythmias.

Fig. 1

Intra-atrial reentry tachycardia ablation in a patient with surgically corrected transposition of the great arteries. Entrainment mapping from right isthmus with concealed atrial entrainment and good post pacing interval.