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Griffiths J, Liang J, Khairy P, Srivatsa UN, Frankel D, Sandhu A, Shoemaker MB, Natale A, Lakkireddy D, De Groot NMS, Gerstenfeld E, Moore JP, Avila P, Ernst S, Nguyen DT. Catheter ablation for atrial fibrillation in adult congenital heart disease: an international registry study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Life expectancies for patients with congenital heart disease (CHD) have dramatically increased in recent years, accompanied by a rise in atrial fibrillation (AF) prevalence. Data on AF ablation strategy and outcomes are limited in CHD.
Purpose
We aimed to investigate the characteristics of CHD patients presenting for AF ablation and their outcomes.
Methods
A multicenter, retrospective analysis was performed of CHD patients undergoing AF ablation between 2004 and 2020 at 13 participating centers. The severity of CHD was classified using the 2014 PACES/HRS guidelines. Clinical data were collected including ablation strategy and follow up. One-year procedural success was defined as freedom from AF in the absence of antiarrhythmic drugs (AADs, complete) or including previously failed AADs (partial).
Results
Of 240 patients, 127 (53.4%) had persistent AF, 62.5% were male, and mean age was 55.2±0.9 years. CHD complexity categories included 147 (61.3%) simple, 69 (28.8%) intermediate and 25 (10.4%) severe. The most common CHD type was atrial septal defect (n=78). More complex CHD conditions included transposition of the great arteries (n=14), anomalous pulmonary veins (n=13), tetralogy of Fallot (n=8), cor triatriatum (n=7), single ventricle physiology (n=2), among others. The majority (71.3%) of patients had AF despite at least one AAD. 46 patients (22.1%) had a reduced systemic ventricular ejection fraction <50%, and the mean left atrial diameter was 44.1±0.7 mm. PV isolation (PVI) was performed in 227 patients (94.6%); additional ablation strategies included left atrial linear ablations (25.4%), CFAE (19.2%), and cavotricuspid isthmus ablation (40.8). One-year complete and partial success rates were 45.0% and 20.5%, respectively, with no significant difference in the rate of complete success between complexity groups. Overall, 38 patients (15.8%) required more than one ablation procedure. There were 3 (1.3%) major and 13 (5.4%) minor procedural complications.
Conclusion
AF ablation in this complex population was safe and resulted in AF control in the majority of patients. Future work should address the most appropriate ablation targets in the challenging population.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Griffiths
- Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust , London , United Kingdom
| | - J Liang
- University of Michigan , Ann Arbor , United States of America
| | - P Khairy
- Montreal Heart Institute , Montreal , Canada
| | - U N Srivatsa
- University of California-Davis , Sacramento , United States of America
| | - D Frankel
- University of Pennsylvania , Philadelphia , United States of America
| | - A Sandhu
- University of Colorado , Aurora , United States of America
| | - M B Shoemaker
- Vanderbilt University Medical Center , Nashville , United States of America
| | - A Natale
- Texas cardiac Arrhythmia , Austin , United States of America
| | - D Lakkireddy
- University of Kansas Medical Center , Kansas City , United States of America
| | - N M S De Groot
- Erasmus University Medical Centre , Rotterdam , The Netherlands
| | - E Gerstenfeld
- University of California San Francisco , San Francisco , United States of America
| | - J P Moore
- University of California Los Angeles , Los Angeles , United States of America
| | - P Avila
- University of California Los Angeles , Los Angeles , United States of America
| | - S Ernst
- Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust , London , United Kingdom
| | - D T Nguyen
- Stanford University Medical Center , Stanford , United States of America
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