Author + information
- Received September 7, 2018
- Revision received October 18, 2018
- Accepted October 22, 2018
- Published online April 15, 2019.
- Christopher S. Grubb, BSa,
- Matthew Lewis, MDb,
- William Whang, MD, MSc,
- Angelo Biviano, MD, MPHa,
- Kathleen Hickey, EdD, FNP, ANPa,
- Marlon Rosenbaum, MDb and
- Hasan Garan, MDa,∗ ()
- aCardiac Electrophysiology Unit, Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
- bDivision of Cardiology, Department of Medicine, Schneeweiss Adult Congenital Heart Center, Columbia University Medical Center, New York, New York
- cHelmsley Center for Electrophysiology, Division of Cardiology, Mount Sinai Health System, New York, New York
- ↵∗Address for correspondence:
Dr. Hasan Garan, Cardiac Electrophysiology Unit, Division of Cardiology, Department of Medicine, 161 Fort Washington Avenue, Suite 648, New York, New York 10032.
Objectives This study sought to determine the electrophysiological predictors of acute procedural success and of post-ablation recurrence of atrial tachyarrhythmias (ATs) in our adult congenital heart disease (ACHD) population undergoing catheter ablation for treatment of AT.
Background Catheter ablation is frequently performed to treat persistent AT in ACHD. The predictors of post-ablation AT recurrence have not been well studied in the ACHD population.
Methods The authors performed a retrospective study of all catheter ablations for treatment of AT performed in ACHD patients between December 1, 2005, and July 20, 2017, at Columbia University Medical Center. Pre-specified clinical and procedural data of interest and the time from ablation to recurrence were determined by chart and procedure report review.
Results A total of 140 patients (mean age: 45 years) underwent catheter ablation for 182 AT. Of the AT, 179 (93%) were intra-atrial macro-re-entrant tachycardia, and 12 (7%) had a focal origin. The presence of a single mechanism was a predictor of acute procedural success that could be achieved in 89% of the patients. At a median of 49.9 months, 62 patients (44%) had recurrent AT. Time to recurrence was significantly shorter (12.5 months) for recurrent AT in 13 of the 20 patients with previous Fontan procedure. By multivariable analysis, acute procedural success was a positive predictor and prior surgical maze procedure was a negative predictor of AT-free survival. Of the 62 patients with recurrent AT, 42 (68%) had a second catheter ablation procedure, and in 22 of these, the AT mechanism was different than previously observed.
Conclusions Catheter ablation for AT in ACHD patients is an effective method of arrhythmia control. More than 1 AT mechanism per patient is common. Acute procedural success is a predictor of freedom from AT recurrence. The majority of patients achieve multiple arrhythmia-free years.
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Dr. Hickey has received funding from the National Institutes of Health. 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 September 7, 2018.
- Revision received October 18, 2018.
- Accepted October 22, 2018.
- 2019 The Authors