Contact force monitoring during catheter ablation of intraatrial reentrant tachycardia in patients with congenital heart disease

Repeat Radiofrequency Catheter Ablation of Atrial Tachycardias in Patients with Congenital Heart Disease

INTRODUCTION

Atrial tachycardias (AT) in patients with congenital heart disease (CHD) are significantly contributing to morbidity and mortality. Aim of this study was to evaluate the long-term course of CHD patients requiring repeat ablation procedures (RAP) of AT.

PATIENTS AND METHODS

All 144 patients with CHD who had undergone ablation of AT at our center between January 2003 and October 2018 were enrolled. Patients were classified according to complexity of CHD: complex CHD (cCHD), moderate CHD (mCHD) and simple CHD (sCHD).

RESULTS

A total of 101 RAP were performed in 64 patients. One RAP was performed in n=40, two in n=13, three in n=10 and 5 in n=1. Acute success rate was 82% (83/101) and was not associated with complexity of CHD (p=1.0). Number of procedures was lower in patients with sCHD than in patients with mCHD and cCHD (sCHD 1.3±0.6, mCHD 1.8±1.0 and cCHD 1.8±1.1, p=0.04). RAP were most frequent in patients after Fontan palliation or Atrial switch procedure (2.0±1.1 (n=41) vs. 1.6±0.9 all others, p=0.016) and in patients with multiple unstable AT´s (2.5±1.1 (n=11) vs. 1.7±1.0, p=0.008). Major complications occurred in 4/101 procedures. Complete follow-up was available in 125 patients. Since last RAP 73% of the patients were in sinus/atrial rhythm and 34/125 patients (27%) with AT recurrence did not require re-ablation with mean follow-up of 52±40 months.

CONCLUSIONS

Recurrences after ablation of AT in CHD patients were frequent. After RAP promising long-term results could be achieved. Data encourage repetitive ablation procedures in this patient population. This article is protected by copyright. All rights reserved.

High density mapping and catheter ablation of atrial tachycardias in adults with congenital heart disease

AIMS

We used a new grid-style multi-electrode mapping catheter (Advisor™ HD Grid, Abbott) and investigated its use for high density mapping of atrial tachycardias in adult patients with congenital heart disease.

PATIENTS AND METHODS

All patients with congenital heart disease who had mapping of atrial tachycardias using the new grid-style catheter between March 2018 and April 2019 were included.

RESULTS

A total of 24 adult patients had high density mapping of atrial tachycardias using the grid-style multi-electrode catheter. Mean procedure duration was 207 ± 72 min., mean fluoroscopy time was 7.1 ± 7.9 min. In patients with right atrial substrates, fluoroscopy time was shorter compared to biatrial or left atrial substrates (0.9 ± 2.2 min for right atrial substrates, n = 19 vs. 6.3 ± 8.3 min for left atrial substrates, n = 2 and 7.5 ± 4.3 min for biatrial substrates, n = 3, p = 0.01). A mean number of 14.814 ± 10.140 endocardial points were collected and 2.319 ± 1244 points were finally used to characterize the tachycardia. Procedural success was achieved in 21/24 (88%) subjects and partial success in 2/24 (8%) patients. Recurrence rate was low (12.5%). In one patient, radiofrequency ablation within the cavotricuspid isthmus resulted in occlusion of a branch of the right coronary artery. No complications related to the use of the mapping catheter itself occurred.

CONCLUSION

High density mapping of AT using the grid-style catheter showed promising results with respect to procedural and midterm outcome and fluoroscopy time. Using the grid-style catheter might offer advantages compared to other multi-electrode catheters used for high density mapping of AT in patients with CHD.

Electrophysiology and structural interventions in adults with congenital heart disease: Comparison of combined versus separate procedures

BACKGROUND

Electrophysiologic (EP) and structural interventions in adult congenital heart disease (ACHD) are typically completed during separate hospital encounters. With planning/coordination, these cases can be combined.

OBJECTIVES

We hypothesized that this integrated approach would yield patient and health system benefits.

METHODS

Consecutive ACHD patients undergoing combined interventions were matched to controls with identical but separate procedures. Primary endpoints of total hospital length of stay and cost were compared.

RESULTS

Sixty-six combined cases and 120 controls were identified (45% male, mean age 36.2 ± 14.2 years). The most common diagnoses were Fontan (27%), tetralogy of Fallot (23%), and transposition complexes (20%). The most common EP procedure was catheter ablation (n = 30) followed by electrophysiologic study (n = 13); the most common structural intervention was transcatheter valve replacement (n = 16) followed by angioplasty/stenting (n = 14). Compared to controls, cases showed shorter anesthesia duration (323 [IQR 238-405] vs. 355 minutes [270-498], P = 0.06), smaller contrast dose (130 [50-189] vs. 177 mL [94-228], P = 0.045), fewer venipunctures (4 [3-4] vs. 6 [5-7], P < 0.001), and fewer work days missed (2 [2-5] vs. 4 [4-6], P < 0.001). There was shorter hospital stay (30 [19-35] vs. 38 hours [26-50], P = 0.023) and a 37% reduction in hospital charges ($117,894 vs. $187,648; P = 0.039) and 27% reduction in payments ($65,757 vs. $88,859; P = 0.016), persisting after adjustment for group differences. There were no significant differences in number of complications or efficacy.

CONCLUSIONS

There appear to be advantages to combining ACHD interventional procedures that include reductions in hospital length of stay and cost, without detectable difference in procedural outcome.