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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Catheter Ablation for Atrial Fibrillation in Adult Congenital Heart Disease: An International Multicenter Registry
Jack R Griffiths1, Udi Nussinovitch2, Jackson J Liang3
1Royal Brompton Hospital (Guy's and St Thomas' NHS Foundation Trust) & National Heart Lung Institute, Imperial College London, United Kingdom (J.R.G., S.E.).
Insights
Atrial fibrillation (AF) ablation in patients with congenital heart disease (CHD) is safe and effective for AF control, irrespective of CHD complexity. Further research is needed to optimize ablation targets for this population.
Area of Science:
- Cardiology
- Electrophysiology
- Congenital Heart Disease
Background:
- Limited data exist on atrial fibrillation (AF) ablation outcomes in patients with congenital heart disease (CHD).
- Investigating AF ablation characteristics and outcomes in CHD patients is crucial.
Purpose of the Study:
- To analyze the characteristics and outcomes of AF ablation in patients with CHD.
- To evaluate the safety and efficacy of AF ablation across different CHD complexity levels.
Main Methods:
- A multicenter, retrospective analysis of 240 patients with CHD undergoing AF ablation (2004-2020).
- CHD severity classified using established guidelines; one-year procedural success defined as freedom from AF/atrial tachycardia without or with minimal antiarrhythmic drugs.
Main Results:
- Persistent AF was common (53.4%); mean age was 55.2 years. Most patients had simple (61.3%) or intermediate (28.3%) CHD.
- One-year complete and partial success rates were 45.0% and 20.5%, respectively. No significant difference in success based on CHD complexity.
- Procedural complications were low (1.3% major, 5.4% minor); 15.8% required repeat procedures.
Conclusions:
- AF ablation in CHD patients is safe and achieves AF control in most cases, regardless of disease complexity.
- Further research should focus on identifying optimal ablation strategies for this complex patient group.
Background:
Data on atrial fibrillation (AF) ablation and outcomes are limited in patients with congenital heart disease (CHD). We aimed to investigate the characteristics of patients with CHD presenting for AF ablation and their outcomes.
Methods:
A multicenter, retrospective analysis was performed of patients with CHD undergoing AF ablation between 2004 and 2020 at 13 participating centers. The severity of CHD was classified using 2014 Pediatric and Congenital Electrophysiology Society/Heart Rhythm Society guidelines. Clinical data were collected. One-year complete procedural success was defined as freedom from atrial tachycardia or AF in the absence of antiarrhythmic drugs or including previously failed antiarrhythmic drugs (partial success).
Results:
Of 240 patients, 127 (53.4%) had persistent AF, 62.5% were male, and mean age was 55.2±13.3 years. CHD complexity categories included 147 (61.3%) simple, 68 (28.3%) 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 trialed at least one antiarrhythmic drug. Forty-six patients (22.1%) had reduced systemic ventricular ejection fraction <50%, and mean left atrial diameter was 44.1±8.2 mm. Pulmonary vein isolation was performed in 227 patients (94.6%); additional ablation included left atrial linear ablations (40%), complex fractionated atrial electrogram (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.
Conclusions:
AF ablation in CHD was safe and resulted in AF control in a majority of patients, regardless of complexity. Future work should address the most appropriate ablation targets in this challenging population.
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