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Adults, younger patients with congenital heart disease had similar catheter ablation IART outcomes
Yap S. J Am Coll Cardiol. 2010;56:1589-1596.
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An older adult population with congenital heart disease experienced comparable outcomes with radiofrequency catheter ablation of intra-atrial re-entrant tachycardia compared with younger patients with congenital heart disease, despite age-related structural changes such as atrial hypertrophy and/or fibrosis, atrial dilation and ventricular dysfunction, according to new data.
Researchers retrospectively analyzed clinical records of adults with congenital heart disease who underwent radiofrequency catheter ablation (RFCA) of intra-atrial re-entrant tachycardia (IART). This included 193 procedures performed in 130 patients with a mean age of 40 ± 13 years.
Overall, when restricted to patients in which an ablation was performed, 82 of 118 (69%) initially attempted RFCAs were successful, which was defined as termination of all IART circuits.
The median clinical follow-up of 3.7 years was reported in 77 patients who had successful RFCA. The rate of IART reoccurrence was 48%, with independent predictors being older age and Fontan palliation. Additionally, 42% of patients had cardioversion/reablation and 4% died. A predictor of successful RFCA included use of electroanatomic mapping, whereas Fontan palliation and Mustard repair were predictive of unsuccessful RFCA.
“In this older cohort of adult [congenital heart disease] patients with IART, the acute and late success of RFCA was similar to that reported for younger patient cohorts, including pediatric and adolescent patients,” Yap and colleagues wrote. “Older age, however, is associated with a higher risk of IART recurrence.” This, they added, likely reflects the complex and evolving underlying pathophysiologic substrate in congenital heart disease, as they encountered a different IART circuit from that of the initial presentation in most patients experiencing a recurrence.
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