Author + information
- Received July 12, 2017
- Revision received May 22, 2018
- Accepted May 29, 2018
- Published online October 15, 2018.
- Pablo Ávila, MDa,b,
- Francis Bessière, MD, MSa,
- Blandine Mondésert, MDa,
- Sylvia Abadir, MDa,
- Annie Dore, MDa,
- François-Pierre Mongeon, MD, MSa,
- Marc Dubuc, MDa and
- Paul Khairy, MD, PhDa,∗ ()
- aAdult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
- bDepartment of Cardiology and Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain
- ↵∗Address for correspondence:
Dr. Paul Khairy, Montreal Heart Institute Adult Congenital Center, Montreal Heart Institute, 5000 Belanger Street East, Montreal, Quebec H1T 1C8, Canada.
Objectives The purpose of this study was to assess the safety and efficacy of cryoablation for perinodal substrates in patients with congenital heart disease (CHD) and a displaced atrioventricular (AV) conduction system or an AV conduction system location that was difficult to predict.
Background Catheter ablation for perinodal arrhythmias in patients with CHD may incur higher risks due to unconventional or difficult to predict locations of the AV conduction system. Cryoablation carries theoretical advantages for such patients but has not been studied in this setting.
Methods A total of 35 patients with CHD underwent cryoablation for perinodal substrates at the Montreal Heart Institute between 2006 and 2016. Ten of these patients, age 33 ± 13 years, 60% male, had AV conduction systems that were displaced or of uncertain location and underwent cryoablation (6-mm electrode-tip catheter) for 12 perinodal arrhythmias: AV nodal re-entrant tachycardia (n = 4), non-automatic focal atrial tachycardia (n = 4), septal intra-atrial re-entrant tachycardia (n = 3), and para-Hisian automatic focal atrial tachycardia (n = 1). Four patients had single-ventricle physiology and had undergone Fontan palliation (3 atriopulmonary and 1 intracardiac total cavopulmonary connection), 4 underwent repair of AV septal defects, 1 had congenitally corrected transposition of the great arteries (TGA), and 1 had TGA with a Mustard baffle.
Results Cryoablation was acutely successful in 9 of 12 targeted arrhythmias (75%) with no procedural complication. Crossover to radiofrequency ablation successfully eliminated the remaining 3 arrhythmias at sites deemed safe by cryoablation, with no complication. Over a follow-up period of 26 (interquartile range: 15 to 64) months, 1 of 9 successfully cryoablated arrhythmias recurred.
Conclusions Cryoablation is feasible, safe, and moderately effective for perinodal arrhythmia substrates in patients with various forms of CHD associated with AV conduction systems that are displaced or in locations that cannot be reliably predicted.
Supported by the Montreal Heart Institute Foundation. Dr. Ávila has received research support from the Alfonso Martín Escudero Foundation, Spain. Dr. Bessière is supported by the French Federation of Cardiology. Dr. Khairy holds the Research Chair in Electrophysiology and Congenital Heart Disease. Dr. Dubuc has consulted for Medtronic CryoCath LP. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received July 12, 2017.
- Revision received May 22, 2018.
- Accepted May 29, 2018.
- 2018 American College of Cardiology Foundation
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