Catheter ablation of atrial fibrillation using 2nd-generation cryoballoon in congenital heart disease patients - significance of RF ablation of additional atrial macro-reentrant tachycardia

Catheter ablation for patients with anomalous pulmonary venous return and atrial fibrillation: a case report and literature review

Background

Anomalous pulmonary venous return involves the partial or complete absence of a connection between the pulmonary veins and the left atrium. The pulmonary vein potential plays a vital role in atrial fibrillation, and catheter ablation to isolate the pulmonary vein is crucial for treating this condition. However, when anomalous pulmonary venous return is present, it makes ablation more challenging and increases the risk of atrial fibrillation recurrence after the procedure.

Case summary

A 49-year-old man was hospitalized because he had been experiencing occasional palpitations for 2 months. He had previously undergone surgery to repair an atrial septal defect when he was 11 years old, during which an issue with the right inferior pulmonary vein was identified but left unaddressed. Electrocardiography upon admission showed atrial fibrillation. Left atrial computed tomography angiography revealed that following atrial septal repair surgery, the right inferior pulmonary vein drained into the right atrium. The patient underwent transcatheter radiofrequency ablation to electrically isolate the pulmonary vein with anomalous return. After 12 months of follow-up, there was no atrial fibrillation recurrence.

Discussion

When performing catheter ablation for anomalous pulmonary venous return and atrial fibrillation, it is essential to consider ablating the irregular pulmonary vein before surgery. This helps to reduce surgical complications and the likelihood of atrial fibrillation recurrence. This case report highlights the challenges encountered during ablation in patients with atrial fibrillation and anomalous pulmonary venous return. In addition, we have reviewed the literature to offer insights into the development of ablation strategies for similar patients.

Atrial Fibrillation Ablation in Congenital Heart Disease: Therapeutic Challenges and Future Perspectives

The increasing prevalence of atrial fibrillation (AF) in adults with congenital heart disease raises significant questions regarding its management. The unique underlying anatomic and physiological background further adds to the difficulty in eliminating the AF burden in these patients. Herein, we provide an overview of the current knowledge on the pathophysiology and risk factors for AF in adult congenital heart disease, with a special focus on the existing challenges in AF ablation. Emerging imaging modalities and ablation techniques might have a role to play. Evidence regarding the safety and efficacy of AF ablation in adult congenital heart disease is summarized, especially for patients with an atrial septal defect, Ebstein anomaly of the tricuspid valve, tetralogy of Fallot, and Fontan circulation. Finally, any remaining gaps in knowledge and potential areas of future research are highlighted.