CLINICAL STUDY
Influence of patient factors and ablative technologies on outcomes of radiofrequency ablation of intra-atrial re-entrant tachycardia in patients with congenital heart disease
John K. Triedman, MD, FACC*,*,
Mark E. Alexander, MD*,
Barry A. Love, MD, FACC ,
Kathryn K. Collins, MD ,
Charles I. Berul, MD, FACC*,
Laura M. Bevilacqua, MD* and
Edward P. Walsh, MD, FACC*
* Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
Division of Cardiology, Montreal Children’s Hospital, Montreal, Canada
Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
Manuscript received September 21, 2001;
revised manuscript received February 14, 2002,
accepted March 1, 2002.
* Reprint requests and correspondence: Dr. John Triedman, Department of Cardiology, Children’s Hospital, 300 Longwood Avenue, Boston, Massachusetts 02115.
john.triedman{at}tch.harvard.edu
OBJECTIVES: The goal of this study was to identify factors associated with radiofrequency catheter ablation (RFCA) outcomes of intra-atrial re-entrant tachycardia (IART).
BACKGROUND: Radiofrequency catheter ablation of IART is difficult. The influence of patient and procedural factors and novel technologies on outcomes is unknown.
METHODS: Acute and chronic RFCA outcomes were studied in patients with congenital heart disease and IART. Clinical status was measured using a multiaxis severity score. Multivariate analyses identified associations of clinical, procedural and technological factors with outcomes.
RESULTS: A total of 177 procedures were performed in 134 patients; 139 procedures (79%) resulted in RFCA of  1 IART circuit and 117 (66%) in RFCA of all targeted circuits. Multivariate analysis associated acute success with irrigated ablation and absence of atrial fibrillation. Twenty-two complications were noted, nine related to vascular access. Electroanatomic mapping failed to decrease procedure or fluoroscopy time. Improvement in clinical status occurred in most patients (severity score preablation: 6.2 ± 1.6, postablation: 3.0 ± 2.3, p < 0.0001). At mean follow-up of 25 ± 11 months, 42% of patients had IART recurrence and 28% required cardioversion. Six deaths occurred (1.8%/patient-year), and two patients underwent transplant. Chronic outcomes were associated with higher right atrial saturations, use of electroanatomic mapping, fewer IART circuits encountered and acute procedural success.
CONCLUSIONS: Improvement of acute RFCA outcomes was contemporaneous with introduction of novel technologies. Intra-atrial re-entrant tachycardia recurrence was common, and no effect on mortality was discerned, but most patients had effective palliation of symptoms. Chronic outcome predictors included the underlying disease severity, application of novel technologies and successful ablation of all targeted arrhythmia circuits.
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Abbreviations and Acronyms
| | CHD | | congenital heart disease | | IART | | intra-atrial re-entrant tachycardia | | RFCA | | radiofrequency catheter ablation |
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