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

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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.

Original languageEnglish
Pages (from-to)347-356
Number of pages10
JournalActa Cardiologica Sinica
Volume29
Issue number4
Publication statusPublished - Jul 1 2013
Externally publishedYes

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Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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