Author + information
- Received June 13, 2018
- Revision received July 17, 2018
- Accepted August 13, 2018
- Published online October 15, 2018.
- Benjamin M. Moore, MBBSa,b,
- Robert Anderson, MBBSc,d,
- Ashley M. Nisbet, BSc, MBChB, PhDc,
- Manish Kalla, BSc, MBBS, DPhilc,
- Karin du Plessis, PhDe,f,
- Yves d’Udekem, MD, PhDe,f,g,
- Andrew Bullock, MBBSh,
- Rachael L. Cordina, MBBS, PhDa,b,
- Leeanne Grigg, MBBSc,d,
- David S. Celermajer, MBBS, PhD, DSca,b,
- Jonathan Kalman, MBBS, PhDc,d and
- Mark A. McGuire, MBBS, PhDa,b,∗ ()
- aDepartment of Cardiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- bSydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia
- cDepartment of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia
- dDepartment of Medicine, University of Melbourne, Parkville, Victoria, Australia
- eMurdoch Children’s Research Institute, The Royal Children’s Hospital, Parkville, Victoria, Australia
- fDepartment of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- gDepartment of Cardiac Surgery, The Royal Children’s Hospital, Parkville, Victoria, Australia
- hChildren’s Cardiac Centre, Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia
- ↵∗Address for correspondence:
Prof. Mark McGuire, Department of Cardiology, Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales 2050, Australia.
Objectives This study sought to describe atrial arrhythmia mechanisms, acute outcomes, and long-term arrhythmia burdens following catheter ablation in adult atriopulmonary (AP) Fontan patients.
Background Atrial arrhythmias are a significant cause of morbidity and mortality in the AP Fontan population.
Methods Sixty consecutive atrial arrhythmia ablations were reviewed in 42 AP Fontan patients (31 ± 8 years of age), performed between 1998 and 2017. The number of induced and ablated tachycardias was recorded for each case, as well as the ability to ablate the suspected clinical tachycardia. Longer-term arrhythmia burden was assessed by using a 12-point clinical arrhythmia severity score.
Results Intra-atrial re-entrant tachycardia (IART) was induced in 93% of cases (n = 56), atrioventricular re-entrant tachycardia in 2 (3%) and atrioventricular nodal re-entrant tachycardia in a single case. The mean number of tachycardias induced per case was 2.3. The critical isthmus for IART was mapped to the lateral (n = 10), inferolateral (n = 8), posterior/posterolateral (n = 16), or septal (n = 10) systemic venous atrium, or to the pulmonary venous atrium (n = 4). Ablation of all inducible tachycardias was achieved in 62%, ablation of at least one (but not all) inducible tachycardias in 25%, with failure to ablate any tachycardias in 13%. The suspected clinical arrhythmia was ablated in 50 cases (83%). Catheter ablation resulted in a significant reduction in arrhythmia score at 3 to 6, 12, and 24 months, irrespective of whether all inducible tachycardias were ablated, or the suspected clinical arrhythmia only. Twelve patients (29%) underwent at least one repeat ablation procedure, with a mean time between ablations of 2.7 ± 3.0 years. There were no cases of periprocedural death, stroke or cardiac tamponade.
Conclusions Catheter ablation can be a safe and effective intervention that will significantly reduce arrhythmia burden in the AP Fontan patient.
Supported by National Health and Medical Research Council (NHMRC) partnership grant 1076849. Profs. d’Udekem and Kalman are clinician practitioner fellows supported by NHMRC grant 1082186. Dr. d’Udekem is a consultant for Merck Sharpe and Dohme and Actelion. Dr. Kalman has received research support from Biosense Webster, Abbott, and Medtronic. Dr. Anderson is supported by postgraduate scholarships co-funded by NHMRC and Royal Australasian College of Physicians NHMRC Woolcock Scholarship. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Edward P. Walsh, MD, served as Guest Editor for this paper.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the author’s institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received June 13, 2018.
- Revision received July 17, 2018.
- Accepted August 13, 2018.
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.