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 journalArticle

1 Citation (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 1 2013
Externally publishedYes

Fingerprint

Catheter Ablation
Tachycardia
Heart Diseases
Recurrence
Cardiac Arrhythmias
Ectopic Atrial Tachycardia
Atrial Flutter
Anti-Arrhythmia Agents
Pharmacology

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Radiofrequency catheter ablation of atrial tachyarrhythmias in adults with repaired congenital heart disease : Constraints from multiple and new arrhythmic foci. / Chiu, Shuenn Nan; Lin, Jiunn-Lee; Tsai, Chia Ti; Yu, Chih Chieh; Lu, Chun Wei; Chang, Chi Wei; Chang, Chien Chih; Wang, Jou Kou; Wu, Mei Hwan.

In: Acta Cardiologica Sinica, Vol. 29, No. 4, 01.07.2013, p. 347-356.

Research output: Contribution to journalArticle

Chiu, Shuenn Nan ; Lin, Jiunn-Lee ; Tsai, Chia Ti ; Yu, Chih Chieh ; Lu, Chun Wei ; Chang, Chi Wei ; Chang, Chien Chih ; Wang, Jou Kou ; Wu, Mei Hwan. / Radiofrequency catheter ablation of atrial tachyarrhythmias in adults with repaired congenital heart disease : Constraints from multiple and new arrhythmic foci. In: Acta Cardiologica Sinica. 2013 ; Vol. 29, No. 4. pp. 347-356.
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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.",
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T1 - Radiofrequency catheter ablation of atrial tachyarrhythmias in adults with repaired congenital heart disease

T2 - Constraints from multiple and new arrhythmic foci

AU - Chiu, Shuenn Nan

AU - Lin, Jiunn-Lee

AU - Tsai, Chia Ti

AU - Yu, Chih Chieh

AU - Lu, Chun Wei

AU - Chang, Chi Wei

AU - Chang, Chien Chih

AU - Wang, Jou Kou

AU - Wu, Mei Hwan

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AB - 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.

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KW - Antiarrhythmia agents

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KW - Congenital heart disease

KW - Multiple arrhythmias

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