Author + information
- Received January 23, 2018
- Revision received April 2, 2018
- Accepted April 26, 2018
- Published online June 18, 2018.
- Ivo Roca-Luque, MD, PhDa,∗ (, )
- Nuria Rivas-Gándara, MD, PhDa,
- Laura Dos Subirà, MD, PhDb,
- Jaume Francisco Pascual, MDa,
- Antònia Pijuan-Domenech, MDb,
- Jordi Pérez-Rodon, MD, PhDa,
- M.Teresa Subirana-Domenech, MD, PhDb,
- Alba Santos-Ortega, MDa,
- Ferran Rosés-Noguer, MDa,
- Berta Miranda-Barrio, MDb,
- Ignacio Ferreira-Gonzalez, MD, PhDc,
- Jaume Casaldàliga Ferrer, MD, PhDb,
- David García-Dorado García, MD, PhDd and
- Angel Moya Mitjans, MD, PhDa
- aArrhythmia Unit, Cardiology Service, Hospital Universitari Val d’Hebron, Barcelona, Spain
- bGrown-Up Congenital Heart Disease Unit, Hospital Universitari Val d’Hebron, Barcelona, Spain
- cCardiovascular Epidemiology Unit, Cardiology Service, Hospital Universitari Val d’Hebron, Barcelona, Spain
- dCardiology Service, Hospital Universitari Val d’Hebron, Barcelona, Spain
- ↵∗Address for correspondence:
Dr. Ivo Roca-Luque, Unitat d’ Arítmies, Servei de Cardiologia, Hospital Universitari Vall d’ Hebron, Pg Vall d’ Hebron 119-129, 08035 Barcelona, Spain.
Objectives The aim of this study was to analyze the long-term outcomes after intra-atrial re-entrant tachycardia (IART) ablation in congenital heart disease (CHD).
Background IART increases morbidity and mortality in CHD patients. Radiofrequency catheter ablation has evolved into the first-line treatment of this complication.
Methods This was a prospective, single-center study of all consecutive CHD patients who underwent first ablation for IART from January 2009 to December 2015 (n = 94, 39.4% female, age 36.55 ± 14.9 years, follow-up 44.45 ± 22.7 months).
Results During the study period, 130 procedures were performed (n = 94, 1.21 ± 0.41 IART/patient). In the first procedure, 114 IART were ablated (short-term success 74.66%). Forty-nine percent of the patients whose IART was ablated had non-cavotricuspid isthmus (CTI)–related IART (alone or with concomitant CTI IART). After the first ablation, 54.3% maintained sinus rhythm (SR), 23.9% presented with recurrence of the ablated IART, 14.2% developed new IART, and 7.6% presented with atrial fibrillation (AF). After the second radiofrequency catheter ablation, 78.3% were in SR, 8.7% presented with AF, and 23.0% presented with IART (50% new IART). Multivariate predictors of recurrences were non-CTI IART (hazard ratio [HR]: 5.06; 95% confidence interval [CI]: 1.6 to 15.9; p = 0.006), PR interval >200 ms (HR: 4.02; 95% CI: 1.9 to 11.3; p = 0.009), AF induction (HR: 3.11; 95% CI: 1.1 to 9.1; p = 0.04). and previous AF (HR: 3.08; 95% CI: 1.1 to 9.3; p = 0.04). A risk score according multivariate model identified 3 levels of recurrence risk: 5.8%, 20%, and 58.5% (area under the receiver-operating characteristic curve 0.8 ± 0.03; p < 0.0001).
Conclusions Ablation of IART in CHD is a challenging procedure, but after ablation in experienced centers, SR can be maintained in 78.3%. Predictors of recurrences are non-CTI–related IART, long PR interval, and previous or induced AF. A risk score based on these factors can be useful for recurrence prediction.
This work was partially supported by the Instituto de Salud Carlos III–CIBER-CV Fondos FEDER. The 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 January 23, 2018.
- Revision received April 2, 2018.
- Accepted April 26, 2018.
- 2018 American College of Cardiology Foundation
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