Author + information
- Received October 26, 2017
- Revision received January 23, 2018
- Accepted January 29, 2018
- Published online March 28, 2018.
- Christian Sohns, MDa,∗ (, )
- Jan-Hendrik Nürnberg, MDa,
- Joachim Hebe, MDa,
- Wolfgang Duckeck, MDa,
- Rodolfo Ventura, MDa,
- Frank Konietschke, PhDb,
- Cong Cao, BScb,
- Jürgen Siebels, MDa and
- Marius Volkmer, MDa
- aElektrophysiology Bremen, Heart Center Bremen, Bremen, Germany
- bDepartment of Mathematical Sciences, University of Texas at Dallas, Dallas, Texas
- ↵∗Address for correspondence:
Dr. Christian Sohns, Electrophysiology Bremen, Heart Center Bremen, Senator Wesslingstrasse 1, 28277 Bremen, Germany.
Objectives This study aimed to evaluate the impact, safety, and success of atrial fibrillation (AF) ablation in adults with congenital heart disease (ACHD) transferring ablation strategies established in normal hearts.
Background AF is an emerging arrhythmia in ACHD.
Methods Fifty-seven consecutive ACHD (median age 51.1 ± 14.8 years) with drug-refractory AF were analyzed who underwent catheter ablation between 2004 and 2017. CHD was classified according to its complexity into mild (61.4%), moderate (17.5%), and severe (21.1%) lesions. AF ablation was performed in 104 procedures following a sequential ablation approach.
Results Of the 57 patients, 30 underwent corrective surgery, 6 underwent palliative surgery, 5 had catheter interventions, and 16 were natural survivors. Follow-up was available for all patients (median 41 ± 36 months). The median duration of cyanosis was 9.2 ± 19.7 years, and the time of volume or pressure overload prior to corrective surgery or intervention was 26.1 ± 21.2 years and 18.1 ± 15.8 years, respectively. The Kaplan-Meier estimate for arrhythmia-free survival following the index ablation procedure was 63% for 1 year and 22% for 5 years. Performing subsequent ablation procedures (2.0 ± 0.5), the Kaplan-Meier estimate significantly improved, with 99% for 1 year and 83% for 5 years (p < 0.01). Five patients died during follow-up due to their underlying CHD condition or underwent transplantation.
Conclusions AF ablation strategies established in normal hearts can be transferred to ACHD. The treatment is safe and effective with acceptable long-term results. Varying anatomical pre-conditions and the heterogeneous population itself are challenging and contribute toward a higher reablation rate. Therefore, AF ablation in ACHD should be reserved for dedicated and highly specialized teams.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Sohns and Nürnberg contributed equally to this work and are joint first authors.
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 October 26, 2017.
- Revision received January 23, 2018.
- Accepted January 29, 2018.
- 2018 American College of Cardiology Foundation
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