Catheter Ablation of Atrial Fibrillation in Adult Congenital Heart Disease: Procedural Characteristics and Outcomes

被引:4
|
作者
Hu, Tiffany Y. [1 ,2 ]
Janga, Chaitra [2 ]
Amin, Mustapha [3 ]
Tan, Nicholas Y. [2 ]
Hodge, David O. [4 ]
Mehta, Ramila A. [5 ]
McLeod, Christopher J. [6 ]
Chiriac, Anca [6 ]
Miranda, William R. [2 ]
Connolly, Heidi M. [2 ]
Asirvatham, Samuel J. [2 ]
Deshmukh, Abhishek J. [2 ]
Egbe, Alexander C. [2 ]
Madhavan, Malini [2 ]
机构
[1] Mayo Clin, Dept Cardiovasc Dis, 200 First St SW, Rochester, MN 55902 USA
[2] Mayo Clin, Dept Cardiovasc Dis, Rochester, MN USA
[3] Cleveland Clin, Dept Internal Med, Cleveland, OH USA
[4] Mayo Coll Med, Dept Quantitat Hlth Sci, Jacksonville, FL USA
[5] Mayo Coll Med, Dept Quantitat Hlth Sci, Rochester, MN USA
[6] Mayo Clin, Dept Cardiovasc Dis, Jacksonville, FL USA
来源
CIRCULATION-ARRHYTHMIA AND ELECTROPHYSIOLOGY | 2023年 / 16卷 / 08期
关键词
ablation; atrial fibrillation; outcomes; pulmonary vein isolation; quality of life; INTRAATRIAL REENTRANT TACHYCARDIA; PREVALENCE; FLUTTER;
D O I
10.1161/CIRCEP.122.011392
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND:The outcomes of catheter ablation for atrial fibrillation in adults with congenital heart disease are not well described. METHODS:In a retrospective study of adult patients with congenital heart disease who underwent catheter ablation for atrial fibrillation between 2000 and 2020 at Mayo Clinic, procedural characteristics and outcomes were collected. The primary outcomes were atrial arrhythmia (AA) recurrence following a 3-month blanking period and repeat ablation. An arrhythmia clinical severity score was assessed pre- and post-ablation based on the duration of arrhythmia episodes, symptoms, cardioversion frequency, and antiarrhythmic drug use. RESULTS:One hundred forty-five patients (age, 57 & PLUSMN;12 years; 28% female; 63% paroxysmal atrial fibrillation) underwent 198 ablations with a median follow-up of 26 months (interquartile range, 14-69). One hundred ten, 26, and 9 patients had simple, moderate, and complex congenital heart disease, respectively. All patients underwent pulmonary vein isolation, and non-pulmonary vein targets were ablated in 79 (54%). AA recurrence at 12 months was 37% (95% CI, 29%-45%). On univariate analysis, increasing left atrial volume index was associated with higher odds of AA recurrence (odds ratio, 1.03 [1.00-1.06] per 1 mL/m(2) increment; P=0.05). Noninducibility of atrial flutter was predictive of decreased odds of AA recurrence (odds ratio, 0.43 [0.21-0.90]; P=0.03). A second ablation was performed in 43 patients after a median of 20 (interquartile range, 8-37) months. Arrhythmia clinical severity scores improved following ablation, reflecting a decrease in symptoms, cardioversions, and antiarrhythmic drugs. CONCLUSIONS:Catheter ablation of atrial fibrillation is feasible and effective in patients with adult congenital heart disease and reduces symptoms. Recurrence of AA frequently requires repeat ablation.
引用
收藏
页码:437 / 446
页数:10
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