Radiofrequency catheter ablation of atrial tachyarrhythmias in adults with repaired congenital heart disease: Constraints from multiple and new arrhythmic foci

Shuenn Nan Chiu, Jiunn Lee Lin, Chia Ti Tsai, Chih Chieh Yu, Chun Wei Lu, Chi Wei Chang, Chien Chih Chang, Jou Kou Wang, Mei Hwan Wu

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)

Abstract

Background: Radiofrequency catheter ablation (RFCA) for atrial tachyarrhythmias in postoperative congenital heart disease (CHD) patients has a low success rate and a high recurrence rate. This study explores the reasons for these constraints. Methods: A total of 49 consecutive postoperative CHD patients who received RFCA for atrial tachyarrhythmias between 1993 and 2010 were enrolled. Results: Overall, there were 86 RFCA procedures performed, 32 with the conventional method and 54 using CARTO-guided mapping. The interval between the operation and the first ablation was 13 years. Isthmusdependent atrial flutter (AFL)was the most common type of tachycardia (37, 76%), followed by intra-atrial re-entry tachycardia (IART; 37%), and ectopic atrial tachycardia (EAT; 31%). By applying CARTO-guided mapping, the success ratewas elevated compared to that of conventional ablation (84% vs. 56%, p = 0.006), but therewas no improvement in the recurrence rate (22% vs. 28%, p = 0.75).Multiple atrial tachyarrhythmias occurred in 26 (53%) patients, and 17 presented during the initial electrophysiological study. The presence of multiple arrhythmias during the initial study predicted ablation failure or multiple ablations (11/17 vs. 3/32, p < 0.001). Among the 15 patients with new tachyarrhythmias, EAT and IART predominated. However, applying antiarrhythmia agents immediately following ablation may decrease arrhythmia recurrence (1/10 vs. 14/25, p = 0.02). Conclusions: Although electroanatomical mapping improves the results of RFCA in atrial tachyarrhythmias, the recurrence rate remains high because of multiple and new atrial tachyarrhythmias. Therefore, short-term pharmacological treatment following RFCA for positive remodeling should be considered.

Original languageEnglish
Pages (from-to)347-356
Number of pages10
JournalActa Cardiologica Sinica
Volume29
Issue number4
Publication statusPublished - Jul 2013
Externally publishedYes

Keywords

  • Ablation
  • Antiarrhythmia agents
  • Atrial tachyarrhythmia
  • Congenital heart disease
  • Multiple arrhythmias

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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