Catheter ablation of intra-atrial reentrant/focal atrial tachycardia in adult congenital heart disease: Value of final programmed atrial stimulation
| Autor: | Eloi Marijon, Elie Mousseaux, Magalie Ladouceur, Xavier Jouven, Denis Amet, Alice Maltret, Alexandre Zhao, Victor Waldmann, Gilles Soulat, Thomas Lavergne, Akli Otmani, Laurence Iserin, Clément Karsenty |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Heart Defects Congenital Male medicine.medical_specialty Heart disease medicine.medical_treatment Catheter ablation 030204 cardiovascular system & hematology Electrocardiography 03 medical and health sciences 0302 clinical medicine Recurrence Physiology (medical) Internal medicine medicine Humans Tachycardia Atrioventricular Nodal Reentry Heart Atria 030212 general & internal medicine Retrospective Studies business.industry Hazard ratio Retrospective cohort study Middle Aged Ablation medicine.disease Confidence interval Catheter Ablation Cardiology Female Cardiology and Cardiovascular Medicine Focal atrial tachycardia business Atrial stimulation Follow-Up Studies |
| Zdroj: | Heart Rhythm. 17:1953-1959 |
| ISSN: | 1547-5271 |
| DOI: | 10.1016/j.hrthm.2020.05.039 |
| Popis: | Background While outcomes of intra-atrial reentrant/focal atrial tachycardia (IART/FAT) catheter ablation have considerably improved in adult congenital heart disease (ACHD), recurrences remain common with different circuits frequently encountered. Objective We aimed to assess the value of programmed atrial stimulation after successful clinical IART/FAT catheter ablation in patients with ACHD. Methods This is a retrospective study including all patients with ACHD undergoing IART/FAT catheter ablation in a tertiary center. After successful catheter ablation of clinical arrhythmia, survival free from arrhythmia recurrence was analyzed according to whether all inducible IARTs/FATs were targeted. Results From 2004 to 2020, 238 IART/FAT catheter ablation procedures were performed (mean age 44.1 ± 15.0 years; 61.3% men). Acute procedural success of clinical arrhythmia was achieved in 208 procedures (87.4%). Among 122 procedures with programmed atrial stimulation (58.7%), at least 1 other IART/FAT was induced in 61 patients (50%). All inducible IARTs/FATs were ablated in 54 patients (88.5%), whereas 7 patients (11.5%) presented with at least 1 nontargeted inducible IART/FAT. Patients with nontargeted inducible IART/FAT had a higher risk of atrial arrhythmia episodes than did inducible patients treated with ablation of all IARTs/FATs (hazard ratio 5.7; 95% confidence interval 1.7–18.4; P = .004), with 12-month atrial arrhythmias recurrence rates of 22.9% and 77.7%, respectively. Inducible patients with successful ablation of all IARTs/FATs had a risk of recurrence similar to that of noninducible patients (hazard ratio 0.6; 95% confidence interval 0.3–1.3; P = .215). Conclusion Beyond clinical IART/FAT catheter ablation in patients with ACHD, our findings suggest the interest of systematically targeting all remaining inducible arrhythmias, irrespective of whether previously documented. |
| Databáze: | OpenAIRE |
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