Catheter ablation in adults with congenital heart disease: A 15-year perspective from a tertiary centre,Archives of Cardiovascular Diseases

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Catheter ablation in adults with congenital heart disease: A 15-year perspective from a tertiary centre
Archives of Cardiovascular Diseases ( IF 2.3 ) Pub Date : 2021-04-10 , DOI: 10.1016/j.acvd.2020.12.005
Victor Waldmann ₁ , Denis Amet ₂ , Alexandre Zhao ₂ , Magalie Ladouceur ₂ , Akli Otmani ₂ , Clement Karsenty ₂ , Alice Maltret ₃ , Jacky Ollitrault ₂ , Florence Pontnau ₂ , Antoine Legendre ₁ , Emmanuelle Florens ₂ , Laura Munte ₂ , Gilles Soulat ₂ , Elie Mousseaux ₂ , Leonarda Du Puy-Montbrun ₂ , Thomas Lavergne ₂ , Damien Bonnet ₃ , Pascal Vouhé ₂ , Xavier Jouven ₂ , Eloi Marijon ₂ , Laurence Iserin ₁

Affiliation

Background

With the growing adult congenital heart disease (ACHD) population, the number of catheter ablation procedures is expected to dramatically increase. Data reporting experience and evolution of catheter ablation in patients with ACHD, over a significant period of time, remain scarce.

Aim

We aimed to describe temporal trends in volume and outcomes of catheter ablation in patients with ACHD.

Methods

This was a retrospective observational study including all consecutive patients with ACHD undergoing attempted catheter ablation in a large tertiary referral centre over a 15-year period. Acute procedural success rate and freedom from recurrence at 12 and 24 months were analysed.

Results

From November 2004 to November 2019, 302 catheter ablations were performed in 221 patients with ACHD (mean age 43.6 ± 15.0 years; 58.9% male sex). The annual number of catheter ablations increased progressively from four to 60 cases per year (P < 0.001). Intra-atrial reentrant tachycardia/focal atrial tachycardia was the most common arrhythmia (n = 217, 71.9%). Over the study period, acute procedural success rate increased from 45.0% to 93.4% (P < 0.001). Use of irrigated catheters (odds ratio [OR] 4.03, 95% confidence interval [CI] 1.86–8.55), a three-dimensional mapping system (OR 3.70, 95% CI 1.72–7.74), contact force catheters (OR 3.60, 95% CI 1.81–7.38) and high-density mapping (OR 3.69, 95% CI 1.82–8.14) were associated with acute procedural success. The rate of freedom from any recurrence at 12 months increased from 29.4% to 66.2% (P = 0.001). Seven (2.3%) non-fatal complications occurred.

Conclusions

The number of catheter ablation procedures in patients with ACHD has increased considerably over the past 15 years. Growing experience and advances in ablative technologies appear to be associated with a significant improvement in acute and mid-term outcomes.

中文翻译：

先天性心脏病成人导管消融：来自三级中心的 15 年视角

背景

随着成人先天性心脏病 (ACHD) 人口的增长，导管消融手术的数量预计将急剧增加。在相当长的一段时间内，ACHD 患者导管消融的数据报告经验和演变仍然很少。

目的

我们旨在描述 ACHD 患者导管消融的体积和结果的时间趋势。

方法

这是一项回顾性观察研究，包括所有连续 15 年在大型三级转诊中心接受导管消融的 ACHD 患者。分析了 12 个月和 24 个月的急性手术成功率和无复发率。

结果

从 2004 年 11 月到 2019 年 11 月，对 221 名 ACHD 患者（平均年龄 43.6 ± 15.0 岁；58.9% 男性）进行了 302 次导管消融。每年导管消融的数量从每年 4 例逐渐增加到 60 例（P < 0.001）。房内折返性心动过速/局灶性房性心动过速是最常见的心律失常 ( n = 217, 71.9%)。在研究期间，急性手术成功率从 45.0% 增加到 93.4%（P < 0.001）。使用冲洗导管（优势比 [OR] 4.03，95% 置信区间 [CI] 1.86-8.55）、三维标测系统（OR 3.70、95% CI 1.72-7.74）、接触力导管（OR 3.60、95 % CI 1.81–7.38）和高密度标测（OR 3.69，95% CI 1.82–8.14）与急性手术成功相关。12 个月时无复发率从 29.4% 增加到 66.2% ( P = 0.001)。发生了七次（2.3%）非致命性并发症。