Efficacy of radiofrequency ablation for control of intraatrial reentrant tachycardia in patients with congenital heart disease

Department of Cardiology, Children's Hospital, Boston, Massachusetts 02115, USA. triedman@cardio.tch.harvard.edu

BACKGROUND: Intraatrial reentrant tachycardia (IART) is a common problem in patients with congenital heart disease (CHD). The progression of clinical symptoms of IART and their response to radiofrequency (RF) ablation are not yet well described. OBJECTIVES: The objective of the study was to determine the early and midterm success rates of RF ablation in effecting a reduction of clinical arrhythmic events in patients with IART and CHD. METHODS: Clinical records of patients undergoing early, successful RF ablation were analyzed retrospectively to document the occurrence and frequency of documented IART, cardioversion and arrhythmia-related hospital visits before and after ablation. RESULTS: Fifty-five catheterizations for intended RF ablation of IART were performed in 45 patients (mean [+/-SD] age 24.5 +/- 10.5 years, 40 after surgical palliation of CHD). Early success was achieved for one or more IART circuits in 33 patients (73%). Mean clinical follow-up of those patients with successful ablation is 17.4 +/- 11.3 months (total 574 patient-months). Documented IART recurrence was noted after 21 (53%) of 40 early, successful catheterizations in 17 (52%) of 33 patients, with a mean time to recurrence of 4.1 months, often with electrocardiographically novel configurations. A more prolonged and frequent history of IART was a univariate risk factor for recurrence. Seven patients underwent repeat RF ablations, and eight patients were restarted on antiarrhythmic medications after ablation. Two patients who had severe ventricular dysfunction before RF ablation died 1.5 and 11 months after RF ablation without known arrhythmia recurrence. Clinical events related to IART increased steadily in frequency for 24 months before RF ablation. Radiofrequency ablation resulted in a reduction of event frequency to levels significantly lower than those in the 12-month period before RF ablation and not significantly different from those levels observed at baseline 3 to 4 years before RF ablation. CONCLUSIONS: In patients with successful RF ablation, the frequency of subsequent events was reduced compared with the 2 preceding years. However, recurrence of IART in patients who showed clinical improvement was frequent, and often revealed the presence of new IART configurations.

This article has been cited by other articles:

				E. P. Walsh Interventional Electrophysiology in Patients With Congenital Heart Disease Circulation, June 26, 2007; 115(25): 3224 - 3234. [Full Text] [PDF]

				E. P. Walsh and F. Cecchin Arrhythmias in Adult Patients With Congenital Heart Disease Circulation, January 30, 2007; 115(4): 534 - 545. [Full Text] [PDF]

				F. Drago, M. S. Silvetti, G. Grutter, and A. De Santis Long term management of atrial arrhythmias in young patients with sick sinus syndrome undergoing early operation to correct congenital heart disease Europace, July 1, 2006; 8(7): 488 - 494. [Abstract] [Full Text] [PDF]

				J. Weipert, C. Noebauer, C. Schreiber, M. Kostolny, B. Zrenner, A. Wacker, J. Hess, and R. Lange Occurrence and management of atrial arrhythmia after long-term Fontan circulation J. Thorac. Cardiovasc. Surg., February 1, 2004; 127(2): 457 - 464. [Abstract] [Full Text] [PDF]

				C. H. Davos, D. P. Francis, M. F.E. Leenarts, S.-C. Yap, W. Li, P. A. Davlouros, R. Wensel, A. J.S. Coats, M. Piepoli, N. Sreeram, et al. Global Impairment of Cardiac Autonomic Nervous Activity Late After the Fontan Operation Circulation, September 9, 2003; 108(90101): II-180 - 185. [Abstract] [Full Text] [PDF]

				M. D. Cheitlin, W. F. Armstrong, G. P. Aurigemma, G. A. Beller, F. Z. Bierman, J. L. Davis, P. S. Douglas, D. P. Faxon, L. D. Gillam, T. R. Kimball, et al. ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography: summary article: a report of the American college of cardiology/American heart association task force on practice guidelines (ACC/AHA/ASE committee to update the 1997 guidelines for the clinical application of echocardiography) J. Am. Coll. Cardiol., September 3, 2003; 42(5): 954 - 970. [Full Text] [PDF]

				M. D. Cheitlin, W. F. Armstrong, G. P. Aurigemma, G. A. Beller, F. Z. Bierman, J. L. Davis, P. S. Douglas, D. P. Faxon, L. D. Gillam, T. R. Kimball, et al. ACC/AHA/ASE 2003 Guideline Update for the Clinical Application of Echocardiography: Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography) Circulation, September 2, 2003; 108(9): 1146 - 1162. [Full Text] [PDF]

				The Task Force on the Management of Grown Up Conge, Task Force members, J. Deanfield, E. Thaulow, C. Warnes, G. Webb, F. Kolbel, A. Hoffman, K. Sorenson, H. Kaemmerer, et al. Management of Grown Up Congenital Heart Disease Eur. Heart J., June 1, 2003; 24(11): 1035 - 1084. [Full Text] [PDF]

				S. P. Setty, K. Finucane, J. R. Skinner, and A. R. Kerr Extracardiac conduit with a limited maze procedure for the failing Fontan with atrial tachycardias Ann. Thorac. Surg., December 1, 2002; 74(6): 1992 - 1997. [Abstract] [Full Text] [PDF]

				H. Nakagawa and W. M. Jackman Catheter ablation of macroreentrant atrial tachycardia in patients following atriotomy Eur. Heart J., October 2, 2002; 23(20): 1566 - 1568. [Full Text] [PDF]

				G. S. Kopf, D. M. Mello, K. M. Kenney, J. Moltedo, N. R. Rollinson, and C. S. Snyder Intraoperative radiofrequency ablation of the atrium: effectiveness for treatment of supraventricular tachycardia in congenital heart surgery Ann. Thorac. Surg., September 1, 2002; 74(3): 797 - 804. [Abstract] [Full Text] [PDF]

				Grown-up congenital heart (GUCH) disease: current needs and provision of service for adolescents and adults with congenital heart disease in the UK Heart, September 1, 2002; 88(90001): i1 - 14. [Abstract] [Full Text] [PDF]

				B. J. Deal, C. Mavroudis, C. L. Backer, S. H. Buck, and C. Johnsrude Comparison of Anatomic Isthmus Block With the Modified Right Atrial Maze Procedure for Late Atrial Tachycardia in Fontan Patients Circulation, July 30, 2002; 106(5): 575 - 579. [Abstract] [Full Text] [PDF]

				J. K. Triedman, M. E. Alexander, B. A. Love, K. K. Collins, C. I. Berul, L. M. Bevilacqua, and E. P. Walsh Influence of patient factors and ablative technologies on outcomes of radiofrequency ablation of intra-atrial re-entrant tachycardia in patients with congenital heart disease J. Am. Coll. Cardiol., June 5, 2002; 39(11): 1827 - 1835. [Abstract] [Full Text] [PDF]

				J. K Triedman Arrhythmias in adults with congenital heart disease Heart, April 1, 2002; 87(4): 383 - 389. [Full Text] [PDF]

				J.-P. Pfammatter, B. Wagner, P. Berdat, D. C. G. Bachmann, M. Pavlovic, J. Pfenninger, and T. Carrel Procedural factors associated with early postoperative arrhythmias after repair of congenital heart defects J. Thorac. Cardiovasc. Surg., February 1, 2002; 123(2): 258 - 262. [Abstract] [Full Text] [PDF]

				M. Tritto, R. de Ponti, M. Zardini, G. Spadacini, and J. A. Salerno-Uriarte Bystander cavo-tricuspid isthmus activation during post-incisional intra-atrial reentrant tachycardia Europace, January 1, 2002; 4(1): 91 - 97. [Abstract] [PDF]

				J. G. Akar, L. C. Kok, D. E. Haines, J. P. DiMarco, and J. P. Mounsey Coexistence of type I atrial flutter and intra-atrial re-entrant tachycardia in patients with surgically corrected congenital heart disease J. Am. Coll. Cardiol., August 1, 2001; 38(2): 377 - 384. [Abstract] [Full Text] [PDF]

				T. Paul, B. Windhagen-Mahnert, T. Kriebel, H. Bertram, R. Kaulitz, T. Korte, M. Niehaus, and J. Tebbenjohanns Atrial Reentrant Tachycardia After Surgery for Congenital Heart Disease : Endocardial Mapping and Radiofrequency Catheter Ablation Using a Novel, Noncontact Mapping System Circulation, May 8, 2001; 103(18): 2266 - 2271. [Abstract] [Full Text] [PDF]

				E. Delacretaz, L. I. Ganz, K. Soejima, P. L. Friedman, E. P. Walsh, J. K. Triedman, L. J. Sloss, M. J. Landzberg, and W. G. Stevenson Multiple atrial macro-re-entry circuits in adults with repaired congenital heart disease: entrainment mapping combined with three-dimensional electroanatomic mapping J. Am. Coll. Cardiol., May 1, 2001; 37(6): 1665 - 1676. [Abstract] [Full Text] [PDF]

				J. K. Triedman, M. E. Alexander, C. I. Berul, L. M. Bevilacqua, and E. P. Walsh Electroanatomic Mapping of Entrained and Exit Zones in Patients With Repaired Congenital Heart Disease and Intra-Atrial Reentrant Tachycardia Circulation, April 24, 2001; 103(16): 2060 - 2065. [Abstract] [Full Text] [PDF]

				H. Nakagawa, N. Shah, K. Matsudaira, E. Overholt, K. Chandrasekaran, K. J. Beckman, P. Spector, J. D. Calame, A. Rao, C. Hasdemir, et al. Characterization of Reentrant Circuit in Macroreentrant Right Atrial Tachycardia After Surgical Repair of Congenital Heart Disease : Isolated Channels Between Scars Allow "Focal" Ablation Circulation, February 6, 2001; 103(5): 699 - 709. [Abstract] [Full Text] [PDF]

				T. R. Betts, P. R. Roberts, S. A. Allen, A. P. Salmon, B. R. Keeton, M. P. Haw, and J. M. Morgan Electrophysiological Mapping and Ablation of Intra-Atrial Reentry Tachycardia After Fontan Surgery With the Use of a Noncontact Mapping System Circulation, July 25, 2000; 102(4): 419 - 425. [Abstract] [Full Text] [PDF]

				S. A. Thorne, I. Barnes, P. Cullinan, and J. Somerville Amiodarone-Associated Thyroid Dysfunction : Risk Factors in Adults With Congenital Heart Disease Circulation, July 13, 1999; 100(2): 149 - 154. [Abstract] [Full Text] [PDF]