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Waldmann V, Bessière F, Gardey K, Hascoët S, Henaine R, Iserin L, Ladouceur M, Bonnet D, Marijon E, Maltret A, Combes N, de Groot N. Catheter ablation of atrial tachyarrhythmias in patients with atrioventricular septal defect. Europace 2023; 25:euad275. [PMID: 37695311 PMCID: PMC10516589 DOI: 10.1093/europace/euad275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/22/2023] [Indexed: 09/12/2023] Open
Abstract
AIMS The incidence of atrial tachyarrhythmias is high in patients with atrioventricular septal defect (AVSD). No specific data on catheter ablation have been reported so far in this population. We aimed to describe the main mechanisms of atrial tachyarrhythmias in patients with AVSD and to analyse outcomes after catheter ablation. METHODS AND RESULTS This observational multi-centric cohort study enrolled all patients with AVSD referred for catheter ablation of an atrial tachyarrhythmia at six tertiary centres from 2004 to 2022. The mechanisms of the different tachyarrhythmias targeted were described and outcomes were analysed. Overall, 56 patients (38.1 ± 17.4 years, 55.4% females) were included. A total of 87 atrial tachyarrhythmias were targeted (mean number of 1.6 per patient). Regarding main circuits involved, a cavo-annular isthmus-dependent intra-atrial re-entrant tachycardia (IART) was observed in 41 (73.2%) patients and an IART involving the right lateral atriotomy in 10 (17.9%) patients. Other tachyarrhythmias with heterogeneous circuits were observed in 13 (23.2%) patients including 11 left-sided and 4 right-sided tachyarrhythmias. Overall, an acute success was achieved in 54 (96.4%) patients, and no complication was reported. During a mean follow-up of 2.8 ± 3.8 years, 22 (39.3%) patients had at least one recurrence. Freedom from atrial tachyarrhythmia recurrences was 77.5% at 1 year. Among 15 (26.8%) patients who underwent repeated ablation procedures, heterogeneous circuits including bi-atrial and left-sided tachyarrhythmias were more frequent. CONCLUSION In patients with AVSD, most circuits involve the cavo-annular isthmus, but complex mechanisms are frequently encountered in patients with repeated procedures. The acute success rate is excellent, although recurrences remain common during follow-up.
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Affiliation(s)
- Victor Waldmann
- Université Paris Cité, Inserm, PARCC, 56 rue Leblanc, F-75015 Paris, France
- Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, 20 rue Leblanc, 75015 Paris, France
- M3C-Necker, Hôpital Universitaire Necker-Enfants malades, APHP, 149 rue de Sèvres, 75015 Paris, France
- Cardiac Electrophysiology Unit, European Georges Pompidou Hospital, 20 rue Leblanc, 75015 Paris, France
| | - Francis Bessière
- Cardiology Department, Louis Pradel Hospital, Hospices Civils de Lyon, Université Lyon 1 Claude Bernard, 50 boulevard Pinel, 69500 Bron, France
| | - Kevin Gardey
- Cardiology Department, Louis Pradel Hospital, Hospices Civils de Lyon, Université Lyon 1 Claude Bernard, 50 boulevard Pinel, 69500 Bron, France
| | - Sébastien Hascoët
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, Paris, France
| | - Roland Henaine
- Cardiology Department, Louis Pradel Hospital, Hospices Civils de Lyon, Université Lyon 1 Claude Bernard, 50 boulevard Pinel, 69500 Bron, France
| | - Laurence Iserin
- Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, 20 rue Leblanc, 75015 Paris, France
| | - Magalie Ladouceur
- Université Paris Cité, Inserm, PARCC, 56 rue Leblanc, F-75015 Paris, France
- Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, 20 rue Leblanc, 75015 Paris, France
| | - Damien Bonnet
- Université Paris Cité, Inserm, PARCC, 56 rue Leblanc, F-75015 Paris, France
- M3C-Necker, Hôpital Universitaire Necker-Enfants malades, APHP, 149 rue de Sèvres, 75015 Paris, France
| | - Eloi Marijon
- Université Paris Cité, Inserm, PARCC, 56 rue Leblanc, F-75015 Paris, France
- Cardiac Electrophysiology Unit, European Georges Pompidou Hospital, 20 rue Leblanc, 75015 Paris, France
| | - Alice Maltret
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, Paris, France
| | - Nicolas Combes
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, Paris, France
- Electrophysiology Unit, Pasteur Clinic, 45 avenue de Lombez, 31300 Toulouse, France
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El-Medany A, Sunderland N, Dobson R, Stuart G, Nisbet A. Catheter ablation for supraventricular arrhythmias in adults with congenital heart disease: Recurrence rates and predictors of acute procedural success. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2023. [DOI: 10.1016/j.ijcchd.2023.100445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
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Waldmann V, Guichard JB, Marijon E, Khairy P. Tachyarrhythmias in Congenital Heart Diseases: From Ion Channels to Catheter Ablation. J Cardiovasc Dev Dis 2022; 9:jcdd9020039. [PMID: 35200693 PMCID: PMC8878440 DOI: 10.3390/jcdd9020039] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/13/2022] [Accepted: 01/20/2022] [Indexed: 12/04/2022] Open
Abstract
Major advances in pediatric cardiology in recent decades, especially surgical techniques, have resulted in an increasing number of patients with congenital heart disease (CHD) surviving to adulthood. This has generated new challenges, particularly with regards to the late onset of complex arrhythmias. Abnormal anatomy, surgical scarring, chronic hypoxemia, hemodynamic compromise, neuro-hormonal abnormalities, and genetic factors can all contribute to creating a unique substrate for arrhythmia development. This review attempts to synthesize the current state of knowledge spanning the spectrum from underlying mechanisms of arrhythmias in patients with congenital heart disease to current ablative strategies. We discuss existing knowledge gaps and highlight important areas for future research.
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Affiliation(s)
- Victor Waldmann
- Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, 75015 Paris, France
- Pediatric and Congenital Cardiology Medico-Surgical Unit, Necker Enfants Malades Hospital, 75015 Paris, France
- Faculté de Médicine, Université de Paris, 75006 Paris, France;
- Correspondence:
| | - Jean-Baptiste Guichard
- Cardiology Department, University Hospital of Saint-Étienne, 42000 Saint-Étienne, France;
- Department of Medicine, Montreal Heart Institute Research Center, Université de Montréal, Montreal, QC H1T 1C8, Canada
| | - Eloi Marijon
- Faculté de Médicine, Université de Paris, 75006 Paris, France;
- Department of Cardiology, European Georges Pompidou Hospital, 75015 Paris, France
| | - Paul Khairy
- Electrophysiology Service and Adult Congenital Heart Centre, Montreal Heart Institute, University of Montreal, Montreal, QC H1T 1C8, Canada;
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Moore JP, Burrows A, Gallotti RG, Shannon KM. Electrophysiological characteristics of atrial tachycardia recurrence: Relevance to catheter ablation strategies in adults with congenital heart disease. Heart Rhythm 2021; 19:272-280. [PMID: 34628040 DOI: 10.1016/j.hrthm.2021.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 09/30/2021] [Accepted: 10/03/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Catheter ablation outcomes for adults with congenital heart disease (ACHDs) are described, but recurrence mechanisms remain largely unknown. OBJECTIVE The purpose of this study was to identify the electrophysiological characteristics of atrial tachycardia (AT) recurrence in ACHD. METHODS ACHD AT procedures over a 10-year period were explored for AT or atrial fibrillation (AF) recurrence. RESULTS At 299 procedures in 250 ACHD (mean age 39 ± 15 years; 52% male), 464 ATs (360 intra-atrial reentrant tachycardia, 104 focal AT; median 2 [IQR 1-3] ATs per procedure) were targeted. Complete (n = 256 [86%]) or partial (n = 37 [12%]) success was achieved in 98% of procedures. Over a median of 3.0 (IQR 1.4-5.3) years of follow-up, 67 patients (27%) developed AT/AF recurrence after the index procedure. Recurrent vs index tachycardias were more often focal AT (38% vs 19%; P < .001), demonstrated longer cycle length (325 ms vs 280 ms; P = .003), required isoproterenol (50% vs 32%; P = .03), and involved the pulmonary venous atrium (PVA)/septum (53% vs 27%; P < .001). AF history (hazard ratio [HR] 2.0; interquartile range [IQR] 1.2-3.4; P = .01), incomplete success (HR 3.6; IQR 2.1-6.4; P < .001), and PVA substrate (HR 2.1; IQR 1.2-3.5; P = .006) were independently associated with AT/AF recurrence. After complete index procedure success and no AF history, 5-year actuarial freedom from AT/AF and AT alone were 77% and 80%. CONCLUSION After catheter ablation in ACHD, repeat ATs were frequently focal, requiring isoproterenol administration, or involved intra-atrial reentrant tachycardia within the PVA or atrial septum. Negative factors were partial success, index PVA substrate, and remote history of AF. These data support aggressive pharmacological provocation to eliminate all inducible tachycardias and coexisting PVA substrates at index procedures for ACHD.
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Affiliation(s)
- Jeremy P Moore
- Division of Cardiology, Department of Medicine, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California; UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California; Division of Cardiology, Department of Pediatrics, UCLA Health System, Los Angeles, California.
| | - Austin Burrows
- David Geffen School of Medicine, Los Angeles, California
| | - Roberto G Gallotti
- Division of Cardiology, Department of Medicine, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California; UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California; Division of Cardiology, Department of Pediatrics, UCLA Health System, Los Angeles, California
| | - Kevin M Shannon
- Division of Cardiology, Department of Medicine, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California; UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California; Division of Cardiology, Department of Pediatrics, UCLA Health System, Los Angeles, California
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Atrial flutter catheter ablation in adult congenital heart diseases. Indian Pacing Electrophysiol J 2021; 21:291-302. [PMID: 34157427 PMCID: PMC8414331 DOI: 10.1016/j.ipej.2021.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/11/2021] [Accepted: 06/16/2021] [Indexed: 02/08/2023] Open
Abstract
The important increase in life expectancy of adult patients with congenital heart disease (ACHD) has generated new challenges, including arrhythmias that represent one of the main late complications. Reentrant atrial arrhythmias are by far the main mechanism encountered, and catheter ablation has been now presented as a first-line therapy in this patient population. The number of procedures is expected to continuously increase year after year. The heterogeneity and complexity of phenotypes encountered require these cases to be performed by highly experienced operators, in specialized centers with multidisciplinary competencies. A thorough knowledge and understanding of anatomic specificities, vascular access issues, and main circuits encountered according to underlying phenotype is essential. Acute success rates have significantly improved and are now excellent, but recurrences remain a common issue, with different mechanisms or circuits frequently encountered. Observational data have suggested the interest of systematically targeting all inducible atrial arrhythmias, whether previously documented or not, and a lot of hope and research is based on the prediction of arrhythmia substrate before arrhythmia development by imaging or electroanatomic mapping to deliver a prophylactic patient tailored ablation approach. In this review, we summarize those different points in the most common or distinctive defects to offer a didactic overview of atrial flutter catheter ablation in ACHD patients.
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