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1
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Lengauer S, Erhard N, Popa MA, Telishevska M, Krafft H, Bahlke F, Englert F, Bourier F, Reents T, Deisenhofer I, Hessling G. Very High-Power Short-Duration Ablation for Atrial Fibrillation in Adults With Congenital Heart Disease. J Cardiovasc Electrophysiol 2025; 36:625-631. [PMID: 39853802 PMCID: PMC11903373 DOI: 10.1111/jce.16567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2024] [Revised: 11/29/2024] [Accepted: 12/23/2024] [Indexed: 01/26/2025]
Abstract
INTRODUCTION Data regarding safety and long-term outcome of very high-power-short duration (vHPSD) ablation in adult congenital heart disease (ACHD) patients with paroxysmal or persistent atrial fibrillation (AF) are lacking. METHODS Retrospective observational single-center study. The data of 66 consecutive ACHD patients (mean age 60 ± 12.8 years, 46% male) with mild (69.7%), moderate (22.7%), or complex (7.6%) congenital heart disease (CHD) who underwent ablation for paroxysmal (40.9%) or persistent AF (59.1%) were analyzed. Circumferential PVI was performed in all patients and additional substrate ablation in 79,4% of persistent AF patients using irrigated RF energy with vHPSD settings of 70 W/5-7 s or 60 W/7-10 s. RESULTS Mean procedure time was 123.6 ± 42 min with a mean RF time of 18.19 ± 10 min. No technique related adverse events occurred. Vascular access complications were detected in seven patients (10.6%) requiring intervention in four patients (6%). A median follow-up time of 491 days (IQR: 194-1054 days). Freedom from any atrial arrhythmia off antiarrhythmic drugs (AAD) at 1 year was present in 58% of patients (77.8% with paroxysmal AF, 43.6% with persistent AF). CONCLUSION vHPSD for ablation of paroxysmal or persistent AF in ACHD patients is safe and effective. Regardless of CHD complexity, no vHPSD ablation modality related complications occurred. Long-term outcome for paroxysmal AF after one ablation was excellent whereas results for persistent AF were limited.
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Affiliation(s)
- Sarah Lengauer
- Department of Electrophysiology, German Heart Center MunichTUM University HospitalMunichBavariaGermany
| | - Nico Erhard
- Department of Electrophysiology, German Heart Center MunichTUM University HospitalMunichBavariaGermany
| | - Miruna A. Popa
- Department of Electrophysiology, German Heart Center MunichTUM University HospitalMunichBavariaGermany
| | - Marta Telishevska
- Department of Electrophysiology, German Heart Center MunichTUM University HospitalMunichBavariaGermany
| | - Hannah Krafft
- Department of Electrophysiology, German Heart Center MunichTUM University HospitalMunichBavariaGermany
| | - Fabian Bahlke
- Department of Electrophysiology, German Heart Center MunichTUM University HospitalMunichBavariaGermany
| | - Florian Englert
- Department of Electrophysiology, German Heart Center MunichTUM University HospitalMunichBavariaGermany
| | - Felix Bourier
- Department of Electrophysiology, German Heart Center MunichTUM University HospitalMunichBavariaGermany
| | - Tilko Reents
- Department of Electrophysiology, German Heart Center MunichTUM University HospitalMunichBavariaGermany
| | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center MunichTUM University HospitalMunichBavariaGermany
| | - Gabriele Hessling
- Department of Electrophysiology, German Heart Center MunichTUM University HospitalMunichBavariaGermany
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2
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O'Connell C, Arps K, Carlisle MA, Schwennesen H, Idriss SF, Kanter R, Piccini JP. Characterization and Localization of Focal Atrial Tachycardia in Patients With Adult Congenital Heart Disease. JACC Clin Electrophysiol 2025; 11:120-131. [PMID: 39880539 DOI: 10.1016/j.jacep.2024.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 08/20/2024] [Accepted: 09/01/2024] [Indexed: 01/31/2025]
Abstract
BACKGROUND In patients with structurally normal hearts, algorithms using surface electrocardiographic P-wave morphology are helpful to predict focal atrial tachycardia (FAT) location. However, these algorithms have not been formally assessed in patients with adult congenital heart disease (ACHD). OBJECTIVES This study sought to assess the efficacy of FAT-location prediction algorithms in an adult population of patients with ACHD. METHODS In this single-center retrospective cross-sectional study, FAT P-waves were classified as: 1) positive; 2) negative; 3) isoelectric; or 4) biphasic. FAT ablation sites identified by electroanatomic mapping were grouped by region: right atrium (RA), paraseptal (PS), and left atrium. Accuracy of P-wave classification criteria to predict FAT region were determined. RESULTS Thirty FATs were assessed in 29 patients (mean age 47 ± 16 years, female 55%, and prior surgical repair in 83%): RA FAT sites-crista terminalis (n = 14), Fontan baffle (n = 3), nonseptal tricuspid annulus (n = 1); PS FAT sites-PS tricuspid annulus (n = 2), coronary sinus ostium (n = 3), foramen ovale (n = 1); and left atrial FAT sites-mitral annulus (n = 2), right superior pulmonary vein (n = 1), left atrial appendage (n = 3). A negative or (±) P-wave in V1 had a 100% specificity for RA origin. Other P-wave morphologies in lead V1 poorly predicted atrial origin. All P-wave morphologies in lead aVL had low sensitivity and specificity for atrial origin. CONCLUSIONS The vast majority of FATs observed in patients with ACHD originate from origins common to those with normal hearts rather than foci unique to ACHD. However, applying algorithms established in patients with normal hearts using P-wave morphology to localize FAT only variably predicts FAT origin in our cohort of ACHD patients.
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Affiliation(s)
- Christine O'Connell
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Kelly Arps
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Matthew A Carlisle
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Hannah Schwennesen
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Salim F Idriss
- Pediatric Cardiac Electrophysiology, Duke Pediatric and Congenital Heart Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Ronald Kanter
- Heart Institute at Nicklaus Children's Hospital, Miami, Florida, USA
| | - Jonathan P Piccini
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA.
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Small AJ, Dai M, Halpern DG, Tan RB. Updates in Arrhythmia Management in Adult Congenital Heart Disease. J Clin Med 2024; 13:4314. [PMID: 39124581 PMCID: PMC11312906 DOI: 10.3390/jcm13154314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/11/2024] [Accepted: 07/18/2024] [Indexed: 08/12/2024] Open
Abstract
Arrhythmias are highly prevalent in adults with congenital heart disease. For the clinician caring for this population, an understanding of pathophysiology, diagnosis, and management of arrhythmia is essential. Herein we review the latest updates in diagnostics and treatment of tachyarrhythmias and bradyarrhythmias, all in the context of congenital anatomy, hemodynamics, and standard invasive palliations for congenital heart disease.
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Affiliation(s)
- Adam J. Small
- Medicine NYU Grossman School of Medicine, 530 First Ave, HCC 5, New York, NY 10016, USA; (M.D.); (D.G.H.); (R.B.T.)
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4
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Brouwer C, Hebe J, Nürnberg JH, Cosedis Nielsen J, Lukac P, de Riva M, Blom N, Zeppenfeld K. Incidence of Atrial Fibrillation After Radiofrequency Catheter Ablation for Atrial Tachycardia in Congenital Heart Disease. JACC Clin Electrophysiol 2024; 10:1050-1060. [PMID: 38613544 DOI: 10.1016/j.jacep.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 01/24/2024] [Accepted: 02/13/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Atrial tachycardia (AT) and atrial fibrillation (AF) coexist in 30% of congenital heart disease (CHD) patients. Successful atrial tachycardia catheter ablation (ATCA) might prevent AF. Data on new-onset AF after ATCA in CHD is scarce. OBJECTIVES This study aimed to evaluate the incidence of new-onset AF after ATCA and to assess clinical characteristics associated with new-onset AF after ATCA in CHD. METHODS CHD patients referred for ATCA to 3 European centers were included. New occurrence of AF was defined as electrocardiographic documentation of AF after any ATCA procedure in patients without history of AF. RESULTS In 277 CHD patients (median age 37 years [Q1, Q3: 23, 49 years], 58% men, 59 [21%] simple, 111 [40%] moderate, and 107 [39%] complex CHD), AF occurred in 25 patients (9%) a median of 8 months (Q1, Q3: 4, 27 months) after ATCA. New-onset AF was persistent in the majority of the patients (17 of 25 [63%]). Patients with new-onset AF were older (44 years [Q1, Q3: 29, 55 years] vs 36 years [Q1, Q3: 23, 49 years]; P = 0.009) and more frequently had simple CHD (13 of 25 [52%] vs 46 of 252 [18%], respectively; P < 0.0001). Acute ATCA success rates were similar in patients with and without AF (52% vs 48%; P = 0.429). Simple CHD was an independent predictor of new-onset AF during follow-up. CONCLUSIONS In our large cohort of patients with congenital heart disease, new-onset AF after ablation for AT occurred in only 9% of the patients. AF occurred without AT recurrence and was persistent in the majority of patients.
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Affiliation(s)
- Charlotte Brouwer
- Department of Cardiology, Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | | | - Peter Lukac
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Marta de Riva
- Department of Cardiology, Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Leiden University Medical Center, Leiden, the Netherlands
| | - Nico Blom
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Katja Zeppenfeld
- Department of Cardiology, Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Leiden University Medical Center, Leiden, the Netherlands.
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Affiliation(s)
- Victor Waldmann
- Unité médico-chirurgicale de Cardiologie Congénitale Adulte, Hôpital Europeen Georges Pompidou, Paris, France
| | - Paul Khairy
- Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada
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Miyazaki A, Tomida J, Tsuneyoshi H, Fujimoto Y, Uemura H. Observation of Atrial Fibrillation Dependent on an Intra-atrial Re-entrant Tachycardia Within the Right Atrium in a Repaired Tetralogy of Fallot. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:51-54. [PMID: 37970106 PMCID: PMC10642099 DOI: 10.1016/j.cjcpc.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/12/2022] [Indexed: 11/17/2023]
Abstract
Atrial fibrillation (AF) can occur predominantly associated with right atrial (RA) lesions in congenital heart disease, particularly when the RA cavity is dilated. RA electrical potentials occasionally appear organized during AF. We clearly mapped such areas circumscribed by an intra-atrial re-entrant circuit during an isoproterenol infusion, in a patient with a repaired tetralogy of Fallot, using an ultrahigh-density mapping system and its beat acceptance criteria function. Ablation of areas inside the re-entrant circuit successfully eliminated the AF. Our experience indicated that a macro-re-entrant tachycardia was a driver as well as a trigger of AF of this right-sided origin.
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Affiliation(s)
- Aya Miyazaki
- Department of Transitional Medicine, Division of Congenital Heart Disease, Shizuoka General Hospital, Shizuoka, Japan
- Department of Adult Congenital Heart Disease and Department of Pediatric Cardiology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
- Congenital Heart Disease Center, Nara Medical University, Nara, Japan
| | - Junya Tomida
- Department of Clinical Engineering, Shizuoka General Hospital, Shizuoka, Japan
| | - Hiroshi Tsuneyoshi
- Department of Cardiovascular Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Yoshifumi Fujimoto
- Department of Transitional Medicine, Division of Congenital Heart Disease, Shizuoka General Hospital, Shizuoka, Japan
| | - Hideki Uemura
- Congenital Heart Disease Center, Nara Medical University, Nara, Japan
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7
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Griffiths JR, Nussinovitch U, Liang JJ, Sims R, Yoneda ZT, Bernstein HM, Viswanathan MN, Khairy P, Srivatsa UN, Frankel DS, Marciniak FE, Sandhu A, Shoemaker MB, Mohanty S, Burkhardt JD, Natale A, Lakkireddy D, De Groot NMS, Gerstenfeld EP, Moore JP, Avila P, Ernst S, Nguyen DT. Catheter Ablation for Atrial Fibrillation in Adult Congenital Heart Disease: An International Multicenter Registry Study. Circ Arrhythm Electrophysiol 2022; 15:e010954. [PMID: 36074954 DOI: 10.1161/circep.122.010954] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Data on atrial fibrillation (AF) ablation and outcomes are limited in patients with congenital heart disease (CHD). We aimed to investigate the characteristics of patients with CHD presenting for AF ablation and their outcomes. METHODS A multicenter, retrospective analysis was performed of patients with CHD undergoing AF ablation between 2004 and 2020 at 13 participating centers. The severity of CHD was classified using 2014 PACES/HRS guidelines. Clinical data were collected. One-year complete procedural success was defined as freedom from atrial tachycardia or AF in the absence of antiarrhythmic drugs or including previously failed antiarrhythmic drugs (partial success). RESULTS Of 240 patients, 127 (53.4%) had persistent AF, 62.5% were male, and mean age was 55.2±0.9 years. CHD complexity categories included 147 (61.3%) simple, 69 (28.8%) intermediate, and 25 (10.4%) severe. The most common CHD type was atrial septal defect (n=78). More complex CHD conditions included transposition of the great arteries (n=14), anomalous pulmonary veins (n=13), tetralogy of Fallot (n=8), cor triatriatum (n=7), single ventricle physiology (n=2), among others. The majority (71.3%) of patients had trialed at least one antiarrhythmic drug. Forty-six patients (22.1%) had reduced systemic ventricular ejection fraction <50%, and mean left atrial diameter was 44.1±0.7 mm. Pulmonary vein isolation was performed in 227 patients (94.6%); additional ablation included left atrial linear ablations (25.4%), complex fractionated atrial electrogram (19.2%), and cavotricuspid isthmus ablation (40.8%). One-year complete and partial success rates were 45.0% and 20.5%, respectively, with no significant difference in the rate of complete success between complexity groups. Overall, 38 patients (15.8%) required more than one ablation procedure. There were 3 (1.3%) major and 13 (5.4%) minor procedural complications. CONCLUSIONS AF ablation in CHD was safe and resulted in AF control in a majority of patients, regardless of complexity. Future work should address the most appropriate ablation targets in this challenging population.
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Affiliation(s)
- Jack R Griffiths
- Royal Brompton Hospital (Guy's and St Thomas' NHS Foundation Trust) & National Heart Lung Institute, Imperial College London, United Kingdom (J.R.G., S.E.)
| | - Udi Nussinovitch
- Section of Electrophysiology, Cardiology Division, Stanford University, CA (U.N., M.N.V., D.T.N.)
| | - Jackson J Liang
- Electrophysiology, Division of Cardiology, Internal Medicine, University of Michigan, Ann Arbor (J.J.L.)
| | - Richard Sims
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN (R.S., Z.T.Y., M.B.S.)
| | - Zachary T Yoneda
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN (R.S., Z.T.Y., M.B.S.)
| | - Hannah M Bernstein
- Division of Cardiovascular Medicine, University of California Davis, Sacramento (H.M.B., U.N.S.)
| | - Mohan N Viswanathan
- Section of Electrophysiology, Cardiology Division, Stanford University, CA (U.N., M.N.V., D.T.N.)
| | - Paul Khairy
- Montreal Heart Institute, Université de Montréal, Canada (P.K.)
| | - Uma N Srivatsa
- Division of Cardiovascular Medicine, University of California Davis, Sacramento (H.M.B., U.N.S.)
| | - David S Frankel
- Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (D.S.F., F.E.M.)
| | - Francis E Marciniak
- Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (D.S.F., F.E.M.)
| | - Amneet Sandhu
- Clinical Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado School of Medicine, Aurora (A.S.)
| | - M Benjamin Shoemaker
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN (R.S., Z.T.Y., M.B.S.)
| | | | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Austin (S.M., J.D.B., A.N.)
| | | | - Natasja M S De Groot
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands (N.M.S.D.G.)
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California San Francisco (E.P.G.)
| | - Jeremy P Moore
- Division of Cardiology, Department of Medicine, UCLA Medical Center, Ahmanson/UCLA Adult Congenital Heart Disease Center & UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA (J.P.M.)
| | - Pablo Avila
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Spain (P.A.)
| | - Sabine Ernst
- Royal Brompton Hospital (Guy's and St Thomas' NHS Foundation Trust) & National Heart Lung Institute, Imperial College London, United Kingdom (J.R.G., S.E.)
| | - Duy Thai Nguyen
- Section of Electrophysiology, Cardiology Division, Stanford University, CA (U.N., M.N.V., D.T.N.)
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8
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De Ponti R, Marazzato J, Angeli F, Vilotta M, Blasi F, Bagliani G, Leonelli FM, Marazzi R. Atypical Cases of Typical Atrial Flutter? A Case Study. Card Electrophysiol Clin 2022; 14:483-494. [PMID: 36153128 DOI: 10.1016/j.ccep.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Ablation of typical atrial flutter has a high safety and efficacy profile, but hidden pitfalls may be encountered. In some cases, a longer cycle length with isoelectric lines is associated with a different or more complex arrhythmogenic substrate, which may be missed if conduction block of the cavotricuspid isthmus is performed in the absence of the clinical arrhythmia. Prior surgery may have consistently modified the atrial substrate and complex or multiple arrhythmias associated with an isthmus-dependent circuit can be encountered. In these cases, electroanatomic mapping is useful to guide the procedure and plan an appropriate ablation strategy.
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Affiliation(s)
- Roberto De Ponti
- Department of Heart and Vessels, Ospedale di Circolo, Viale Borri, 57, Varese 21100, Italy; Department of Medicine and Surgery, University of Insubria, Viale Guicciardini, 9, Varese 21100, Italy.
| | - Jacopo Marazzato
- Department of Heart and Vessels, Ospedale di Circolo, Viale Borri, 57, Varese 21100, Italy; Department of Medicine and Surgery, University of Insubria, Viale Guicciardini, 9, Varese 21100, Italy
| | - Fabio Angeli
- Department of Medicine and Surgery, University of Insubria, Viale Guicciardini, 9, Varese 21100, Italy; Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS, Via Crotto Roncaccio, 16, Tradate, Varese 21049, Italy
| | - Manola Vilotta
- Department of Heart and Vessels, Ospedale di Circolo, Viale Borri, 57, Varese 21100, Italy
| | - Federico Blasi
- Department of Heart and Vessels, Ospedale di Circolo, Viale Borri, 57, Varese 21100, Italy; Department of Medicine and Surgery, University of Insubria, Viale Guicciardini, 9, Varese 21100, Italy
| | - Giuseppe Bagliani
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti Umberto I-Lancisi-Salesi", Via Conca 71, Ancona 60126, Italy
| | - Fabio M Leonelli
- Cardiology Department, James A. Haley Veterans' Hospital, University of South Florida, 13000 Bruce B Down Boulevard, Tampa, FL 33612, USA
| | - Raffaella Marazzi
- Department of Heart and Vessels, Ospedale di Circolo, Viale Borri, 57, Varese 21100, Italy
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9
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Martin de Miguel I, Miranda WR, Madhavan M, Connolly HM, Dearani JA, Egbe AC. Risk Factors for Atrial Arrhythmias in Adults With Ebstein Anomaly. JACC. ADVANCES 2022; 1:100058. [PMID: 38938391 PMCID: PMC11198643 DOI: 10.1016/j.jacadv.2022.100058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/06/2022] [Accepted: 06/17/2022] [Indexed: 06/29/2024]
Abstract
Background Atrial arrhythmias (AA) are common in Ebstein anomaly (EA), but risk factors associated with AA are not well understood. Objectives The purpose of this study was to determine the prevalence and risk factors for AA at baseline, incidence, and risk factors for AA during follow-up. Methods Adults with EA receiving care at Mayo Clinic, MN, between 2003 and 2020 were included. AA was defined as atrial fibrillation (AF) or atrial flutter/tachycardia (AFL). Clinical, echocardiographic, rhythm, surgical data were collected. Results Of 682 patients (aged 36 [24-49] years), 235 (34%) had AA at baseline (126 [18%] AF and 144 [21%] AFL), and the risk factors for AA were age, left and right atrial volume indexes, and reservoir strain. Among 447 patients without AA, 10-year cumulative incidence of AF and AFL was 16% and 22%, respectively. The risk factors for incident AF were older age and right atrial reservoir strain. The risk factors for incident AFL were atrial septal defect, left atrial volume index, and male sex. Among patients with baseline AA, 129 (40%) had recurrent episodes (AF 63 [20%], AFL 78 [24%]). The 5-year recurrence rate of AA was 34%, without significant difference for AF vs AFL (46% vs 27%, P = 0.081). Older age and right atrial reservoir strain were associated with recurrent AF. Conclusions Patients with EA are at risk for incident and recurrent AA. AF was almost as common as AFL despite relatively young ages. Echocardiographic indexes of atrial function can identify at-risk patients, hence be used to improve risk stratification and guide therapy.
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Affiliation(s)
| | - William R. Miranda
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Malini Madhavan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Heidi M. Connolly
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Joseph A. Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Alexander C. Egbe
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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10
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Waldmann V, Guichard JB, Marijon E, Khairy P. Tachyarrhythmias in Congenital Heart Diseases: From Ion Channels to Catheter Ablation. J Cardiovasc Dev Dis 2022; 9:jcdd9020039. [PMID: 35200693 PMCID: PMC8878440 DOI: 10.3390/jcdd9020039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/13/2022] [Accepted: 01/20/2022] [Indexed: 12/04/2022] Open
Abstract
Major advances in pediatric cardiology in recent decades, especially surgical techniques, have resulted in an increasing number of patients with congenital heart disease (CHD) surviving to adulthood. This has generated new challenges, particularly with regards to the late onset of complex arrhythmias. Abnormal anatomy, surgical scarring, chronic hypoxemia, hemodynamic compromise, neuro-hormonal abnormalities, and genetic factors can all contribute to creating a unique substrate for arrhythmia development. This review attempts to synthesize the current state of knowledge spanning the spectrum from underlying mechanisms of arrhythmias in patients with congenital heart disease to current ablative strategies. We discuss existing knowledge gaps and highlight important areas for future research.
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Affiliation(s)
- Victor Waldmann
- Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, 75015 Paris, France
- Pediatric and Congenital Cardiology Medico-Surgical Unit, Necker Enfants Malades Hospital, 75015 Paris, France
- Faculté de Médicine, Université de Paris, 75006 Paris, France;
- Correspondence:
| | - Jean-Baptiste Guichard
- Cardiology Department, University Hospital of Saint-Étienne, 42000 Saint-Étienne, France;
- Department of Medicine, Montreal Heart Institute Research Center, Université de Montréal, Montreal, QC H1T 1C8, Canada
| | - Eloi Marijon
- Faculté de Médicine, Université de Paris, 75006 Paris, France;
- Department of Cardiology, European Georges Pompidou Hospital, 75015 Paris, France
| | - Paul Khairy
- Electrophysiology Service and Adult Congenital Heart Centre, Montreal Heart Institute, University of Montreal, Montreal, QC H1T 1C8, Canada;
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11
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Nürnberg JH, Siebels J, Hebe J. Tachykarde Rhythmusstörungen bei EMAH – Aspekte der katheterinterventionellen Therapie. AKTUELLE KARDIOLOGIE 2021. [DOI: 10.1055/a-1579-0599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ZusammenfassungTachykarde Rhythmusstörungen bei Erwachsenen mit angeborenem Herzfehler (EMAH) haben
großen Einfluss auf Morbidität und Letalität dieser Patientengruppe. Sie basieren in der
Mehrzahl auf erworbenen Substraten, die eine typische Langzeitfolge des angeborenen
Herzfehlers (AHF) insbesondere nach herzchirurgischen Eingriffen darstellen. Antiarrhythmika
können akut effektiv eingesetzt werden, sind aber als langfristige Behandlungsstrategie meist
wenig verlässlich zur Unterdrückung von Tachykardierezidiven. Zusätzlich können
Kontraindikationen bestehen bei eingeschränkter Ventrikelfunktion, hämodynamischen
Rest-Fehlbelastungen, bradykardem Grundrhythmus sowie Arzneimittelnebenwirkungen. Vor diesem
Hintergrund hat sich die katheterinterventionelle Ablationsbehandlung in den beiden letzten
Jahrzehnten als Therapie der Wahl für die Mehrheit der Tachykardieformen bei EMAH mit
zunehmend hohen Erfolgs- und niedrigen Komplikationsquoten etabliert.
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Affiliation(s)
| | - Jürgen Siebels
- Elektrophysiologie Bremen, Am Klinikum Links der Weser, Bremen, Deutschland
| | - Joachim Hebe
- Elektrophysiologie Bremen, Am Klinikum Links der Weser, Bremen, Deutschland
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12
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Moore JP, Burrows A, Gallotti RG, Shannon KM. Electrophysiological characteristics of atrial tachycardia recurrence: Relevance to catheter ablation strategies in adults with congenital heart disease. Heart Rhythm 2021; 19:272-280. [PMID: 34628040 DOI: 10.1016/j.hrthm.2021.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 09/30/2021] [Accepted: 10/03/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Catheter ablation outcomes for adults with congenital heart disease (ACHDs) are described, but recurrence mechanisms remain largely unknown. OBJECTIVE The purpose of this study was to identify the electrophysiological characteristics of atrial tachycardia (AT) recurrence in ACHD. METHODS ACHD AT procedures over a 10-year period were explored for AT or atrial fibrillation (AF) recurrence. RESULTS At 299 procedures in 250 ACHD (mean age 39 ± 15 years; 52% male), 464 ATs (360 intra-atrial reentrant tachycardia, 104 focal AT; median 2 [IQR 1-3] ATs per procedure) were targeted. Complete (n = 256 [86%]) or partial (n = 37 [12%]) success was achieved in 98% of procedures. Over a median of 3.0 (IQR 1.4-5.3) years of follow-up, 67 patients (27%) developed AT/AF recurrence after the index procedure. Recurrent vs index tachycardias were more often focal AT (38% vs 19%; P < .001), demonstrated longer cycle length (325 ms vs 280 ms; P = .003), required isoproterenol (50% vs 32%; P = .03), and involved the pulmonary venous atrium (PVA)/septum (53% vs 27%; P < .001). AF history (hazard ratio [HR] 2.0; interquartile range [IQR] 1.2-3.4; P = .01), incomplete success (HR 3.6; IQR 2.1-6.4; P < .001), and PVA substrate (HR 2.1; IQR 1.2-3.5; P = .006) were independently associated with AT/AF recurrence. After complete index procedure success and no AF history, 5-year actuarial freedom from AT/AF and AT alone were 77% and 80%. CONCLUSION After catheter ablation in ACHD, repeat ATs were frequently focal, requiring isoproterenol administration, or involved intra-atrial reentrant tachycardia within the PVA or atrial septum. Negative factors were partial success, index PVA substrate, and remote history of AF. These data support aggressive pharmacological provocation to eliminate all inducible tachycardias and coexisting PVA substrates at index procedures for ACHD.
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Affiliation(s)
- Jeremy P Moore
- Division of Cardiology, Department of Medicine, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California; UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California; Division of Cardiology, Department of Pediatrics, UCLA Health System, Los Angeles, California.
| | - Austin Burrows
- David Geffen School of Medicine, Los Angeles, California
| | - Roberto G Gallotti
- Division of Cardiology, Department of Medicine, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California; UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California; Division of Cardiology, Department of Pediatrics, UCLA Health System, Los Angeles, California
| | - Kevin M Shannon
- Division of Cardiology, Department of Medicine, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California; UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California; Division of Cardiology, Department of Pediatrics, UCLA Health System, Los Angeles, California
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13
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Brouwer C, Hebe J, Lukac P, Nürnberg JH, Cosedis Nielsen J, de Riva Silva M, Blom N, Hazekamp M, Zeppenfeld K. Contemporary Patients With Congenital Heart Disease: Uniform Atrial Tachycardia Substrates Allow for Clear Ablation Endpoints With Improved Long-Term Outcome. Circ Arrhythm Electrophysiol 2021; 14:e009695. [PMID: 34465129 DOI: 10.1161/circep.120.009695] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Charlotte Brouwer
- Department of Cardiology (C.B., M.d.R., K.Z.), Leiden University Medical Center, the Netherlands
| | - Joachim Hebe
- Center for Electrophysiology, Bremen, Germany (J.H., J.-H.N.)
| | - Peter Lukac
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (P.L., J.C.N.)
| | | | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (P.L., J.C.N.)
| | - Marta de Riva Silva
- Department of Cardiology (C.B., M.d.R., K.Z.), Leiden University Medical Center, the Netherlands
| | - Nico Blom
- Department of Pediatric Cardiology (N.B.), Leiden University Medical Center, the Netherlands
| | - Mark Hazekamp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, the Netherlands (M.H)
| | - Katja Zeppenfeld
- Department of Cardiology (C.B., M.d.R., K.Z.), Leiden University Medical Center, the Netherlands
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14
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Wasmer K, Eckardt L, Baumgartner H, Köbe J. Therapy of supraventricular and ventricular arrhythmias in adults with congenital heart disease-narrative review. Cardiovasc Diagn Ther 2021; 11:550-562. [PMID: 33968633 DOI: 10.21037/cdt-20-634] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Arrhythmias are among the most common late complications in adults with congenital heart disease (ACHD) and a frequent reason for hospital admission. Both, supraventricular and ventricular arrhythmias, not only cause debilitating symptoms, but may be life-threatening by increasing risk of stroke, causing or worsening heart failure and being associated with sudden death. Substrate and risk for arrhythmia differs widely between congenital defects with specific arrhythmias being much more common in some patients than others. Atrial macroreentrant arrhythmias are particularly frequent in patients with atrial septal defects and repair that involves atrial incisions including patients with transposition of the great arteries (TGA) and atrial switch. Accessory pathways and related arrhythmias are often associated with Ebstein's anomaly and congenitally corrected TGA. Monomorphic ventricular arrhythmias occur in patients with ventricular incisions, namely patients with Tetralogy of Fallot. Changes in surgical repair techniques influence arrhythmia prevalence and substrate as well as anatomical access for catheter ablation procedures. In addition, epidemiologic changes associated with improved long-term survival will further increase the prevalence of atrial fibrillation in ACHD. This article summarizes current understanding of prevalence of specific arrhythmias, underlying mechanisms, medical and interventional treatment options and their outcome in ACHD.
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Affiliation(s)
- Kristina Wasmer
- Department of Cardiology II - Electrophysiology, University Hospital Muenster, Cardiology, Muenster, Germany
| | - Lars Eckardt
- Department of Cardiology II - Electrophysiology, University Hospital Muenster, Cardiology, Muenster, Germany
| | - Helmut Baumgartner
- Department of Cardiology III, Division of Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Cardiology, Muenster, Germany
| | - Julia Köbe
- Department of Cardiology II - Electrophysiology, University Hospital Muenster, Cardiology, Muenster, Germany
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15
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de Miguel IM, Ávila P. Atrial Fibrillation in Congenital Heart Disease. Eur Cardiol 2021; 16:e06. [PMID: 33737960 PMCID: PMC7967824 DOI: 10.15420/ecr.2020.41] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 12/08/2020] [Indexed: 01/25/2023] Open
Abstract
The increasing prevalence of AF in a growing population of adults with congenital heart disease (CHD) poses new challenges to clinicians involved in the management of these patients. Distinctive underlying anatomies, unique physiological aspects, a high diversity of corrective surgeries and associated comorbidities can complicate clinical decision-making. In this review, the authors provide an overview of the current knowledge on epidemiology and pathophysiology, with a special focus on the differences to the non-CHD population and the clinical impact of AF in adults with CHD. Acute and long-term management strategies are summarised, including the use of antiarrhythmic drugs, catheter or surgical ablation and prophylaxis of thromboembolism. Finally, gaps of knowledge and potential areas of future research are highlighted.
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Affiliation(s)
- Irene Martín de Miguel
- Cardiology Department, Hospital General Universitario Gregorio Marañón Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón Madrid, Spain.,Faculty of Medicine, Universidad Complutense and CIBERCV Madrid, Spain
| | - Pablo Ávila
- Cardiology Department, Hospital General Universitario Gregorio Marañón Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón Madrid, Spain.,Faculty of Medicine, Universidad Complutense and CIBERCV Madrid, Spain
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16
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Waldmann V, Khairy P. Pathophysiology, Risk Factors, and Management of Atrial Fibrillation in Adult Congenital Heart Disease. Card Electrophysiol Clin 2021; 13:191-199. [PMID: 33516397 DOI: 10.1016/j.ccep.2020.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
A confluence of clinical and epidemiologic factors has provoked a steep increase in the prevalence of atrial fibrillation in adults with congenital heart disease. Atrial fibrillation is the most common presenting arrhythmia. Much remains to be unraveled about the mitigating role congenital heart disease, residual hemodynamic defects, surgical ramifications, and shunts and cyanosis on new-onset and recurrent atrial fibrillation in this population. Catheter ablation is increasingly performed for atrial fibrillation. This synopsis provides an overview of current knowledge on atrial fibrillation in adults with congenital heart disease, addresses clinical management, and discusses knowledge gaps and areas for future research.
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Affiliation(s)
- Victor Waldmann
- Electrophysiology and Adult Congenital Heart Disease Unit, Hôpital Européen Georges Pompidou, Université de Paris, 20 Rue Leblanc, 75015 Paris, France
| | - Paul Khairy
- Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
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17
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Waldmann V, Amet D, Zhao A, Ladouceur M, Otmani A, Karsenty C, Maltret A, Soulat G, Mousseaux E, Lavergne T, Jouven X, Iserin L, Marijon E. Catheter ablation of intra-atrial reentrant/focal atrial tachycardia in adult congenital heart disease: Value of final programmed atrial stimulation. Heart Rhythm 2020; 17:1953-1959. [DOI: 10.1016/j.hrthm.2020.05.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/18/2020] [Accepted: 05/31/2020] [Indexed: 11/26/2022]
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18
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Houck CA, Chandler SF, Bogers AJJC, Triedman JK, Walsh EP, de Groot NMS, Abrams DJ. Arrhythmia Mechanisms and Outcomes of Ablation in Pediatric Patients With Congenital Heart Disease. Circ Arrhythm Electrophysiol 2019; 12:e007663. [PMID: 31722541 DOI: 10.1161/circep.119.007663] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In contrast to the adult population with congenital heart disease (CHD), arrhythmia mechanisms and outcomes of ablation in pediatric patients with CHD in recent era have not been studied in detail. Aims of this study were to determine arrhythmia mechanisms and to evaluate procedural and long-term outcomes in pediatric patients with CHD undergoing catheter ablation. METHODS Consecutive patients <18 years of age with CHD undergoing catheter ablation over an 11-year period (2007-2018) were included. Procedural outcome included complete or partial success, failure or empirical ablation. Long-term outcome included arrhythmia recurrence and burden according to a 12-point clinical arrhythmia severity score. RESULTS The study population consisted of 232 patients (11.7 years [0.01-17.8], 33.5 kg [2.2-130.1]). The most common diagnoses were Ebstein's anomaly (n=44), septal defects (n=39), and single ventricle (n=36). Arrhythmia mechanisms included atrioventricular reentry tachycardia (n=104, 90 patients), atrioventricular nodal reentry tachycardia (n=33, 29 patients), twin atrioventricular nodal tachycardia (n=3, 2 patients), macroreentrant atrial tachycardia (n=59, 56 patients), focal atrial tachycardia (n=33, 25 patients), ventricular ectopy (n=10, 8 patients), and ventricular tachycardia (n=15, 13 patients). Fifty-six arrhythmias (39 patients) were undefined. Outcomes included complete success (n=189, 81%), partial success (n=7, 3%), failure (n=16, 7%), or empirical ablation (n=20, 9%). Over 3.6 years (0.3-10.7) arrhythmia recurred in 49%. Independent of arrhythmia recurrence, arrhythmia scores decreased from 4 (0-10) at baseline to 0.5 (0-8) at 4 years follow-up (P<0.001). In 23/51 repeat procedures (45%), a different arrhythmia substrate was found. Overall adverse event rate was 9.4%, although only 1.6% (n=4) were of major severity and 0.8% (n=2) of moderate severity. CONCLUSIONS Pediatric patients with CHD demonstrate a broad spectrum of arrhythmia mechanisms. Despite recurrence and emergence of novel mechanisms after a successful procedure, ablation can be performed safely and successfully resulting in decreased arrhythmia burden.
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Affiliation(s)
- Charlotte A Houck
- Department of Cardiology (C.A.H., N.M.S.d.G.), Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Cardio-Thoracic Surgery (C.A.H., A.J.J.C.B.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Stephanie F Chandler
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA (S.F.C., J.K.T., E.P.W., D.J.A.)
| | - Ad J J C Bogers
- Department of Cardio-Thoracic Surgery (C.A.H., A.J.J.C.B.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - John K Triedman
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA (S.F.C., J.K.T., E.P.W., D.J.A.)
| | - Edward P Walsh
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA (S.F.C., J.K.T., E.P.W., D.J.A.)
| | - Natasja M S de Groot
- Department of Cardiology (C.A.H., N.M.S.d.G.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Dominic J Abrams
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA (S.F.C., J.K.T., E.P.W., D.J.A.)
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19
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Zhang J, Zheng L, Zhou D, Zhao A, Tang C, Zhang Y, Su X. Insight Into the Mechanism of Macroreentrant Atrial Tachycardia With Cycle Length Alternans Using Ultrahigh Density Mapping System. Circ Arrhythm Electrophysiol 2019; 12:e007634. [PMID: 31698935 DOI: 10.1161/circep.119.007634] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Atrial tachycardia (AT) with cycle length (CL) alternans is a rare phenomenon. We aimed to identify the characteristics and precise mechanism of this special category of ATs by using an ultrahigh density mapping system.
Methods:
We identified 7 ATs with alternating CL in a total of 478 ATs from 2 institutions mapped with an ultrahigh density mapping system. Activation maps were performed for long CL (289±35 ms; mapping points, 21 520±11 103) and short CL (251±18 ms; mapping points,17 594±8059) separately.
Results:
We classified ATs with CL alternans into 2 types. Type 1: There existed 2 potential loops with different routes. CL alternans resulted from an intermittently 2:1 conducting block within the channel of the smaller loop. Type 2: CL alternans resulted from different conduction velocity through 2 closely spaced gaps within preexisting linear lesions. Catheter ablation successfully terminated all the 7 ATs.
Conclusions:
Ultrahigh density mapping provides an opportunity to delineate the precise mechanism of AT with CL alternans. Intermittent conduction block or slowing of a channel was essential for the maintenance of AT.
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Affiliation(s)
- Jinlin Zhang
- From the Department of Cardiology, Wuhan Asian Heart Hospital, Hubei, China (J.Z., C.T., Y.Z., X.S.)
| | - Liangrong Zheng
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University, Hangzhou, China (L.Z., D.Z.)
| | - Dongchen Zhou
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University, Hangzhou, China (L.Z., D.Z.)
| | - Anquan Zhao
- Boston Scientific China, Shanghai, China (A.Z.)
| | - Cheng Tang
- From the Department of Cardiology, Wuhan Asian Heart Hospital, Hubei, China (J.Z., C.T., Y.Z., X.S.)
| | - Yonghua Zhang
- From the Department of Cardiology, Wuhan Asian Heart Hospital, Hubei, China (J.Z., C.T., Y.Z., X.S.)
| | - Xi Su
- From the Department of Cardiology, Wuhan Asian Heart Hospital, Hubei, China (J.Z., C.T., Y.Z., X.S.)
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20
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Rychik J, Atz AM, Celermajer DS, Deal BJ, Gatzoulis MA, Gewillig MH, Hsia TY, Hsu DT, Kovacs AH, McCrindle BW, Newburger JW, Pike NA, Rodefeld M, Rosenthal DN, Schumacher KR, Marino BS, Stout K, Veldtman G, Younoszai AK, d'Udekem Y. Evaluation and Management of the Child and Adult With Fontan Circulation: A Scientific Statement From the American Heart Association. Circulation 2019; 140:e234-e284. [PMID: 31256636 DOI: 10.1161/cir.0000000000000696] [Citation(s) in RCA: 530] [Impact Index Per Article: 88.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
It has been 50 years since Francis Fontan pioneered the operation that today bears his name. Initially designed for patients with tricuspid atresia, this procedure is now offered for a vast array of congenital cardiac lesions when a circulation with 2 ventricles cannot be achieved. As a result of technical advances and improvements in patient selection and perioperative management, survival has steadily increased, and it is estimated that patients operated on today may hope for a 30-year survival of >80%. Up to 70 000 patients may be alive worldwide today with Fontan circulation, and this population is expected to double in the next 20 years. In the absence of a subpulmonary ventricle, Fontan circulation is characterized by chronically elevated systemic venous pressures and decreased cardiac output. The addition of this acquired abnormal circulation to innate abnormalities associated with single-ventricle congenital heart disease exposes these patients to a variety of complications. Circulatory failure, ventricular dysfunction, atrioventricular valve regurgitation, arrhythmia, protein-losing enteropathy, and plastic bronchitis are potential complications of the Fontan circulation. Abnormalities in body composition, bone structure, and growth have been detected. Liver fibrosis and renal dysfunction are common and may progress over time. Cognitive, neuropsychological, and behavioral deficits are highly prevalent. As a testimony to the success of the current strategy of care, the proportion of adults with Fontan circulation is increasing. Healthcare providers are ill-prepared to tackle these challenges, as well as specific needs such as contraception and pregnancy in female patients. The role of therapies such as cardiovascular drugs to prevent and treat complications, heart transplantation, and mechanical circulatory support remains undetermined. There is a clear need for consensus on how best to follow up patients with Fontan circulation and to treat their complications. This American Heart Association statement summarizes the current state of knowledge on the Fontan circulation and its consequences. A proposed surveillance testing toolkit provides recommendations for a range of acceptable approaches to follow-up care for the patient with Fontan circulation. Gaps in knowledge and areas for future focus of investigation are highlighted, with the objective of laying the groundwork for creating a normal quality and duration of life for these unique individuals.
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21
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Waldmann V, Laredo M, Abadir S, Mondésert B, Khairy P. Atrial fibrillation in adults with congenital heart disease. Int J Cardiol 2019; 287:148-154. [DOI: 10.1016/j.ijcard.2019.01.079] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/12/2018] [Accepted: 01/22/2019] [Indexed: 12/13/2022]
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22
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Different characteristics of postoperative atrial tachyarrhythmias between congenital and non-congenital heart disease. J Interv Card Electrophysiol 2019; 58:1-8. [PMID: 31197584 DOI: 10.1007/s10840-019-00575-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 05/26/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The chance of encountering tachyarrhythmias has been increasing in adult congenital heart disease (CHD) patients with previous open-heart surgery, along with the improvement of their longevity. However, the characteristics of these arrhythmias remain to be elucidated. METHODS We examined the characteristics of atrial tachyarrhythmias (ATs) in 26 consecutive CHD patients (M/F 17/9) referred for catheter ablation and compared them with 16 non-CHD patients with cardiac surgery (M/F 11/5). RESULTS The CHD group was younger and had a longer period from cardiac surgery until the occurrence of ATs compared with the non-CHD group (44.8 ± 19.5 vs. 67.6 ± 12.5 years old, and 23.3 ± 13.2 vs. 6.3 ± 4.9 years, respectively, both P < 0.05). Multiple ATs were equally induced in both groups, 12 in CHD (46.1%) and 5 in non-CHD (31.3%). Although the prevalence of macro-reentrant ATs (cavo-tricuspid isthmus-dependent atrial flutter (AFL) or intra-atrial reentrant tachycardia (IART)) was comparable, the mechanisms were different between the 2 groups (AFL and IART), 34% and 27% in CHD and 71% and 24% in non-CHD, respectively. Furthermore, focal AT (FAT) was noted in 9 patients (34.6%) in CHD but none in non-CHD (P < 0.05). Electroanatomical mapping showed that the surface area and low-voltage area (LVA) of the right atrium were significantly larger in CHD than in non-CHD (197.1 ± 56.4 vs. 132.4 ± 41.2 cm2, and 40.8 ± 33.3 vs. 13.6 ± 9.0 cm2, respectively, both P < 0.05). Ten out of 14 FATs (71.4%) were highly associated with LVA, especially near the crista terminalis. CONCLUSIONS The development of ATs in CHD patients could be associated with large atrial remodeling, resulting in complicated ATs.
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23
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Guarguagli S, Kempny A, Cazzoli I, Barracano R, Gatzoulis MA, Dimopoulos K, Ernst S. Efficacy of catheter ablation for atrial fibrillation in patients with congenital heart disease. Europace 2019; 21:1334-1344. [DOI: 10.1093/europace/euz157] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/04/2019] [Indexed: 12/12/2022] Open
Abstract
Abstract
Aims
Advances in surgical techniques allow an increasing number of children with congenital heart disease (CHD) to reach adulthood. As patients grow older, atrial fibrillation (AF) is evolving into a major clinical concern and can be difficult to manage medically. Primary AF catheter ablation may, therefore, have a role in this setting but few reports have evaluated its efficacy in CHD patients.
Methods and results
We retrospectively reviewed 58 consecutive patients [median age 51, interquartile range (IQR) 44–63 years, 57% male] with AF (45% paroxysmal) who underwent 122 ablation procedures in our tertiary centre in the last decade. The majority had CHD of moderate or severe complexity (57%, Bethesda Class 2 or 3) with a dilated left atrium (LA) (81%) and/or right atrium (86%). At 1-year from the first ablation, 32.8% of patients remained in sinus rhythm. Multiple procedures were required in 35 (60%) patients. Freedom from AF at 1-year after the 2nd and 3rd ablation was 40.9% and 36.5%, respectively. Multivariable predictors of AF recurrence were underlying anatomic complexity [hazard ratio (HR) in Bethesda 3 1.98, P = 0.006], type of AF (HR for persistent 1.87, P = 0.004), and indexed LA dimensions (HR for cm2/m2 1.06, P = 0.03).
Conclusion
While ablation may be a valid option for the treatment of AF in CHD patients, multiple procedures are likely to be required. Early referral and careful patient selection are essential to optimize the results of AF ablation, achieving a low rate of recurrence. Further studies are needed to validate our prognostic model and guide clinical practice.
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Affiliation(s)
- Silvia Guarguagli
- Department of Cardiology, Royal Brompton and Harefield Hospital and Imperial College London, Sydney St, Chelsea, London, UK
- Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; School of Cardiovascular Disease, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Aleksander Kempny
- Adult Congenital Heart Center and Centre of Pulmonary Hypertension, Royal Brompton and Imperial College London, London, UK
| | - Ilaria Cazzoli
- Department of Cardiology, Royal Brompton and Harefield Hospital and Imperial College London, Sydney St, Chelsea, London, UK
| | - Rosaria Barracano
- Department of Cardiology, Royal Brompton and Harefield Hospital and Imperial College London, Sydney St, Chelsea, London, UK
| | - Michael A Gatzoulis
- Adult Congenital Heart Center and Centre of Pulmonary Hypertension, Royal Brompton and Imperial College London, London, UK
| | - Konstantinos Dimopoulos
- Adult Congenital Heart Center and Centre of Pulmonary Hypertension, Royal Brompton and Imperial College London, London, UK
| | - Sabine Ernst
- Department of Cardiology, Royal Brompton and Harefield Hospital and Imperial College London, Sydney St, Chelsea, London, UK
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Abadir S, Waldmann V, Dyrda K, Laredo M, Mondésert B, Dubuc M, Khairy P. Feasibility and safety of cryoballoon ablation for the treatment of atrial fibrillation in patients with congenital heart disease. World J Cardiol 2019; 11:149-158. [PMID: 31171960 PMCID: PMC6536882 DOI: 10.4330/wjc.v11.i5.149] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/19/2019] [Accepted: 05/14/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The prevalence of atrial fibrillation (AF) is on the rise in the aging population with congenital heart disease (CHD). A few case series have described the feasibility and early outcomes associated with radiofrequency catheter ablation of AF centered on electrically isolating pulmonary veins (PVs) in patients with CHD. In contrast, cryoballoon ablation has not previously been studied in this patient population despite its theoretical advantages, which include a favorable safety profile and shorter procedural time.
AIM To assess the safety and feasibility of cryoballoon ablation for AF in an initial cohort of patients with CHD.
METHODS The study population consisted of consecutive patients with CHD who underwent cryoballoon ablation for AF at the Montreal Heart Institute between December 2012 and June 2017. Procedural complications, acute success, and 1-year freedom from recurrent AF after a single procedure with or without antiarrhythmic drugs were assessed. Procedures were performed under conscious sedation. Left atrial access was obtained via a single transseptal puncture or through an existing atrial septal defect (ASD). Cryoballoon occlusion was assessed by distal injection of 50% diluted contrast into the PV. At least one 240-s cryothermal application was performed when complete PV occlusion was obtained. Following ablation, patients were routinely followed at outpatient visits at 1, 3, 6, and 12 mo, and annually thereafter.
RESULTS Ten patients with a median age of 57.9 (interquartile range 48.2-61.7 years) and 60% female, met the inclusion criteria and were followed for 2.8 (interquartile range 1.4-4.5) years. Two patients had moderately complex CHD (sinus venosus ASD with partial anomalous pulmonary venous return; aortic coarctation with a persistent left superior vena cava), with the remainder having simple defects. AF was paroxysmal in 8 (80.0%) and persistent in 2 (20.0%) patients. The PV anatomy was normal in 6 (60.0%) patients. Four had left common PV (n = 3) and/or 3 right PV (n = 2). Electrical pulmonary vein isolation (PVI) was acutely successful in all patients. One patient had transient phrenic nerve palsy that recovered during the intervention. No major complications occurred. One year after a single ablation procedure, 6 (60%) patients remained AF-free. One patient with recurrent AF had recovered PV conduction and underwent a second PVI procedure. A second patient underwent ablation of an extra-pulmonary vein trigger for AF.
CONCLUSION Cryoballoon ablation for AF is feasible and safe in patients with simple and moderate forms of CHD, with an excellent acute success rate and modest 1-year freedom from recurrent AF.
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Affiliation(s)
- Sylvia Abadir
- Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal QC H1T 1C8, Canada
| | - Victor Waldmann
- Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal QC H1T 1C8, Canada
| | - Katia Dyrda
- Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal QC H1T 1C8, Canada
| | - Mikael Laredo
- Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal QC H1T 1C8, Canada
| | - Blandine Mondésert
- Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal QC H1T 1C8, Canada
| | - Marc Dubuc
- Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal QC H1T 1C8, Canada
| | - Paul Khairy
- Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal QC H1T 1C8, Canada
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25
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Zhou WP, Li F, Wu JJ, Lu YN, Qian YJ. Calcium-handling abnormalities underlying atrial arrhythmogenesis in a Fontan operation canine model. World J Pediatr 2018; 14:576-584. [PMID: 30155616 DOI: 10.1007/s12519-018-0177-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 07/18/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Atrial tachyarrhythmia (AT) is a common complication in patients who have undergone a Fontan operation. In this study, we investigated whether abnormal Ca2+ handling contributes to the Fontan operation-related atrial arrhythmogenic substrate. METHODS Mongrel dogs were randomly assigned to sham and Fontan groups. The Fontan operation model was developed by performing an atriopulmonary anastomosis. After 14 days, an electrophysiological study was performed to evaluate the AT vulnerability. Ca2+ handling properties were measured by loading atrial cardiomyocytes (CMs) with fura-2 AM. The L-type Ca2+ (ICa-L) and Na+-Ca2+ exchanger (INCX) currents of the CMs were recorded by the whole-cell patch-clamp technique. The key Ca2+ handling proteins expression was assessed by Western blotting. RESULTS The AT inducibility was higher in the Fontan group than in the sham group (85.71 vs. 14.29%, P < 0.05). The Fontan operation resulted in decreased Ca2+ transient (CaT) amplitude and sarcoplasmic reticulum (SR) Ca2+ content, but in enhanced diastolic intracellular Ca2+ concentration and SR Ca2+ leak in the atrial CMs. The spontaneous CaT events, triggered ectopic activity and INCX density were increased, but ICa-L density was reduced in CMs from the Fontan atria (all P < 0.05). Additionally, the Fontan operation resulted in decreased SR Ca2+ ATPase expression and Cav1.2 expression, but in increased NCX1 and Ser2814-phosphorylated ryanodine receptor 2. The calmodulin-dependent protein kinase II expression and function were markedly enhanced in the Fontan atria. CONCLUSION The Fontan operation caused atrial CM Ca2+ handling abnormalities that produced arrhythmogenic-triggered activity and increased vulnerability to AT in experimental Fontan dogs.
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Affiliation(s)
- Wan-Ping Zhou
- Cardiology Department, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, 1678 Dongfang Road, Pudong New Area, 200127, Shanghai, China.,Cardiology Department, Children's Hospital of Soochow University, Suzhou, China
| | - Fen Li
- Cardiology Department, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, 1678 Dongfang Road, Pudong New Area, 200127, Shanghai, China.
| | - Jin-Jin Wu
- Cardiology Department, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, 1678 Dongfang Road, Pudong New Area, 200127, Shanghai, China
| | - Ya-Nan Lu
- Cardiology Department, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, 1678 Dongfang Road, Pudong New Area, 200127, Shanghai, China
| | - Yi-Jiao Qian
- Cardiology Department, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, 1678 Dongfang Road, Pudong New Area, 200127, Shanghai, China
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26
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Kollengode M, Mathew J, Yeung E, Sauer WH, Nguyen DT. Successful atrial fibrillation ablation without pulmonary vein isolation utilizing focal impulse and rotor mapping in an atriopulmonary Fontan. HeartRhythm Case Rep 2018; 4:241-246. [PMID: 29922583 PMCID: PMC6006488 DOI: 10.1016/j.hrcr.2018.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Madhukar Kollengode
- Division of Cardiovascular Medicine, University of Colorado, Anschutz Medical Center, Aurora, Colorado.,Division of Cardiology, Children's Hospital Colorado, Aurora, Colorado
| | - Jehu Mathew
- Division of Cardiovascular Medicine, University of Colorado, Anschutz Medical Center, Aurora, Colorado
| | - Elizabeth Yeung
- Division of Cardiovascular Medicine, University of Colorado, Anschutz Medical Center, Aurora, Colorado.,Division of Cardiology, Children's Hospital Colorado, Aurora, Colorado
| | - William H Sauer
- Division of Cardiovascular Medicine, University of Colorado, Anschutz Medical Center, Aurora, Colorado
| | - Duy Thai Nguyen
- Division of Cardiovascular Medicine, University of Colorado, Anschutz Medical Center, Aurora, Colorado
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27
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Hernández-Madrid A, Paul T, Abrams D, Aziz PF, Blom NA, Chen J, Chessa M, Combes N, Dagres N, Diller G, Ernst S, Giamberti A, Hebe J, Janousek J, Kriebel T, Moltedo J, Moreno J, Peinado R, Pison L, Rosenthal E, Skinner JR, Zeppenfeld K, Sticherling C, Kautzner J, Wissner E, Sommer P, Gupta D, Szili-Torok T, Tateno S, Alfaro A, Budts W, Gallego P, Schwerzmann M, Milanesi O, Sarquella-Brugada G, Kornyei L, Sreeram N, Drago F, Dubin A. Arrhythmias in congenital heart disease: a position paper of the European Heart Rhythm Association (EHRA), Association for European Paediatric and Congenital Cardiology (AEPC), and the European Society of Cardiology (ESC) Working Group on Grown-up Congenital heart disease, endorsed by HRS, PACES, APHRS, and SOLAECE. Europace 2018; 20:1719-1753. [DOI: 10.1093/europace/eux380] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Antonio Hernández-Madrid
- Department of Cardiology, Arrhythmia Unit, Ramón y Cajal Hospital, Alcalá University, Carretera Colmenar Viejo, km 9, 100, Madrid, Spain
| | - Thomas Paul
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University Medical Center, Robert-Koch-Str. 40, Göttingen, Germany
| | - Dominic Abrams
- PACES (Pediatric and Congenital Electrophysiology Society) Representative, Department of Cardiology, Boston Childreńs Hospital, Boston, MA, USA
| | - Peter F Aziz
- HRS Representative, Pediatric Electrophysiology, Cleveland Clinic Children's, Cleveland, OH, USA
| | - Nico A Blom
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Academical Medical Center, Amsterdam, The Netherlands
| | - Jian Chen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Massimo Chessa
- Pediatric and Adult Congenital Heart Centre-University Hospital, IRCCS Policlinico San Donato, Milan, Italy
| | - Nicolas Combes
- Arrhythmia Unit, Department of Pediatric and Adult Congenital Heart Disease, Clinique Pasteur, Toulouse, France
| | - Nikolaos Dagres
- Department of Electrophysiology, University Leipzig Heart Center, Leipzig, Germany
| | | | - Sabine Ernst
- Royal Brompton and Harefield Hospital, London, UK
| | - Alessandro Giamberti
- Congenital Cardiac Surgery Unit, Policlinico San Donato, University and Research Hospital, Milan, Italy
| | - Joachim Hebe
- Center for Electrophysiology at Heart Center Bremen, Bremen, Germany
| | - Jan Janousek
- 2nd Faculty of Medicine, Children's Heart Centre, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Thomas Kriebel
- Westpfalz-Klinikum Kaiserslautern, Children’s Hospital, Kaiserslautern, Germany
| | - Jose Moltedo
- SOLAECE Representative, Head Pediatric Electrophysiology, Section of Pediatric Cardiology Clinica y Maternidad Suizo Argentina, Buenos Aires, Argentina
| | - Javier Moreno
- Department of Cardiology, Arrhythmia Unit, Ramón y Cajal Hospital, Alcalá University, Carretera Colmenar Viejo, km 9, 100, Madrid, Spain
| | - Rafael Peinado
- Department of Cardiology, Arrhythmia Unit, Hospital la Paz, Madrid, Spain
| | - Laurent Pison
- Department of Cardiology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Eric Rosenthal
- Consultant Paediatric and Adult Congenital Cardiologist, Evelina London Children's Hospital, Guy's and St Thomas' Hospital Trust, London, UK
| | - Jonathan R Skinner
- APHRS Representative, Paediatric and Congenital Cardiac Services Starship Childreńs Hospital, Grafton, Auckland, New Zealand
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Joseph Kautzner
- Institute For Clinical and Experimental Medicine, Prague, Czech Republic
| | - Erik Wissner
- University of Illinois at Chicago, 840 S. Wood St., 905 S (MC715), Chicago, IL, USA
| | - Philipp Sommer
- Heart Center Leipzig, Struempellstr. 39, Leipzig, Germany
| | - Dhiraj Gupta
- Consultant Electrophysiologist Liverpool Heart and Chest Hospital, Honorary Senior Lecturer Imperial College London and University of Liverpool, Liverpool, UK
| | | | - Shigeru Tateno
- Chiba Cerebral and Cardiovascular Center, Tsurumai, Ichihara, Chiba, Japan
| | | | - Werner Budts
- UZ Leuven, Campus Gasthuisberg, Herestraat 49, Leuven, Belgium
| | | | - Markus Schwerzmann
- INSELSPITAL, Universitätsspital Bern, Universitätsklinik für Kardiologie, Zentrum für angeborene Herzfehler ZAH, Bern, Switzerland
| | - Ornella Milanesi
- Department of Woman and Child's Health, University of Padua, Padua Italy
| | - Georgia Sarquella-Brugada
- Pediatric Arrhythmias, Electrophysiology and Sudden Death Unit, Department of Cardiology, Hospital Sant Joan de Déu, Barcelona - Universitat de Barcelona, Passeig Sant Joan de Déu, 2, Esplugues, Barcelona, Catalunya, Spain
| | - Laszlo Kornyei
- Gottsegen Gyorgy Orszagos Kardiologiai, Pediatric, Haller U. 29, Budapest, Hungary
| | - Narayanswami Sreeram
- Department of Pediatric Cardiology, University Hospital Of Cologne, Kerpenerstrasse 62, Cologne, Germany
| | - Fabrizio Drago
- IRCCS Ospedale Pediatrico Bambino Gesù, Piazza Sant'Onofrio 4, Roma
| | - Anne Dubin
- Division of Pediatric Cardiology, 750 Welch Rd, Suite 321, Palo Alto, CA, USA
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28
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Teuwen CP, de Groot NMS. Atrial Fibrillation: The Next Epidemic for Patients With Congenital Heart Disease. J Am Coll Cardiol 2017; 70:2949-2950. [PMID: 29216992 DOI: 10.1016/j.jacc.2017.08.080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 08/30/2017] [Indexed: 11/28/2022]
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29
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Klehs S, Schneider HE, Backhoff D, Paul T, Krause U. Radiofrequency Catheter Ablation of Atrial Tachycardias in Congenital Heart Disease. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.117.005451. [DOI: 10.1161/circep.117.005451] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 11/06/2017] [Indexed: 11/16/2022]
Abstract
Background
Radiofrequency catheter ablation has become the treatment strategy of choice for atrial tachyarrhythmias in patients with congenital heart disease (CHD). We analyzed results of radiofrequency catheter ablation in a large cohort of patients with CHD with special reference to complexity of underlying anatomy.
Methods and Results
One hundred and forty-four patients with CHD and atrial tachyarrhythmias undergoing radiofrequency catheter ablation were classified according to complexity of underlying CHD: simple CHD, n=18 (12%); moderate CHD, n=53 (37%); and complex CHD, n=73 (51%). Overall acute success was achieved in 81% of the patients. Acute success was lower for tachycardias involving the left atrium compared with right atrial tachycardias. Complexity of CHD was associated with longer procedure duration. Tachycardia recurrence was observed in 54% of the patients after a total follow-up of 7.4 years. 75% of all recurrences occurred within the first year. Recurrence of tachycardia was more likely in patients with complex surgical atrial anatomy (ie, Fontan palliation or atrial switch procedure). Major complications occurred in 4 patients and were related to vascular access.
Conclusions
Acute procedural success of atrial tachycardia ablation in congenital heart patients was not influenced by complexity of CHD. Long-term outcome with regard to tachycardia recurrence was worse in patients with complex surgical atrial anatomy.
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Affiliation(s)
- Sophia Klehs
- From the Department of Pediatric Cardiology and Pediatric Intensive Care Medicine, University Medical Center, Georg August University Göttingen, Germany
| | - Heike E. Schneider
- From the Department of Pediatric Cardiology and Pediatric Intensive Care Medicine, University Medical Center, Georg August University Göttingen, Germany
| | - David Backhoff
- From the Department of Pediatric Cardiology and Pediatric Intensive Care Medicine, University Medical Center, Georg August University Göttingen, Germany
| | - Thomas Paul
- From the Department of Pediatric Cardiology and Pediatric Intensive Care Medicine, University Medical Center, Georg August University Göttingen, Germany
| | - Ulrich Krause
- From the Department of Pediatric Cardiology and Pediatric Intensive Care Medicine, University Medical Center, Georg August University Göttingen, Germany
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30
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Ávila P, Oliver JM, Gallego P, González-García A, Rodríguez-Puras MJ, Cambronero E, Ruiz-Cantador J, Campos A, Peinado R, Prieto R, Sarnago F, Yotti R, Fernández-Avilés F. Natural History and Clinical Predictors of Atrial Tachycardia in Adults With Congenital Heart Disease. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.117.005396. [DOI: 10.1161/circep.117.005396] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 07/26/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Pablo Ávila
- From the Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain (P.Á., J.M.O., R.P., F.S., R.Y., F.F.-A.); Adult Congenital Heart Disease Unit, Hospital Universitario La Paz, Madrid, Spain (J.M.O., A.G.-G., E.C., J.R.-C., R.P.); and Intercenter Congenital Heart Disease Unit, Hospital Virgen del Rocío y Virgen Macarena, Sevilla, Spain (P.G., M.J.R
| | - José María Oliver
- From the Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain (P.Á., J.M.O., R.P., F.S., R.Y., F.F.-A.); Adult Congenital Heart Disease Unit, Hospital Universitario La Paz, Madrid, Spain (J.M.O., A.G.-G., E.C., J.R.-C., R.P.); and Intercenter Congenital Heart Disease Unit, Hospital Virgen del Rocío y Virgen Macarena, Sevilla, Spain (P.G., M.J.R
| | - Pastora Gallego
- From the Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain (P.Á., J.M.O., R.P., F.S., R.Y., F.F.-A.); Adult Congenital Heart Disease Unit, Hospital Universitario La Paz, Madrid, Spain (J.M.O., A.G.-G., E.C., J.R.-C., R.P.); and Intercenter Congenital Heart Disease Unit, Hospital Virgen del Rocío y Virgen Macarena, Sevilla, Spain (P.G., M.J.R
| | - Ana González-García
- From the Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain (P.Á., J.M.O., R.P., F.S., R.Y., F.F.-A.); Adult Congenital Heart Disease Unit, Hospital Universitario La Paz, Madrid, Spain (J.M.O., A.G.-G., E.C., J.R.-C., R.P.); and Intercenter Congenital Heart Disease Unit, Hospital Virgen del Rocío y Virgen Macarena, Sevilla, Spain (P.G., M.J.R
| | - María José Rodríguez-Puras
- From the Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain (P.Á., J.M.O., R.P., F.S., R.Y., F.F.-A.); Adult Congenital Heart Disease Unit, Hospital Universitario La Paz, Madrid, Spain (J.M.O., A.G.-G., E.C., J.R.-C., R.P.); and Intercenter Congenital Heart Disease Unit, Hospital Virgen del Rocío y Virgen Macarena, Sevilla, Spain (P.G., M.J.R
| | - Esther Cambronero
- From the Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain (P.Á., J.M.O., R.P., F.S., R.Y., F.F.-A.); Adult Congenital Heart Disease Unit, Hospital Universitario La Paz, Madrid, Spain (J.M.O., A.G.-G., E.C., J.R.-C., R.P.); and Intercenter Congenital Heart Disease Unit, Hospital Virgen del Rocío y Virgen Macarena, Sevilla, Spain (P.G., M.J.R
| | - José Ruiz-Cantador
- From the Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain (P.Á., J.M.O., R.P., F.S., R.Y., F.F.-A.); Adult Congenital Heart Disease Unit, Hospital Universitario La Paz, Madrid, Spain (J.M.O., A.G.-G., E.C., J.R.-C., R.P.); and Intercenter Congenital Heart Disease Unit, Hospital Virgen del Rocío y Virgen Macarena, Sevilla, Spain (P.G., M.J.R
| | - Ana Campos
- From the Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain (P.Á., J.M.O., R.P., F.S., R.Y., F.F.-A.); Adult Congenital Heart Disease Unit, Hospital Universitario La Paz, Madrid, Spain (J.M.O., A.G.-G., E.C., J.R.-C., R.P.); and Intercenter Congenital Heart Disease Unit, Hospital Virgen del Rocío y Virgen Macarena, Sevilla, Spain (P.G., M.J.R
| | - Rafael Peinado
- From the Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain (P.Á., J.M.O., R.P., F.S., R.Y., F.F.-A.); Adult Congenital Heart Disease Unit, Hospital Universitario La Paz, Madrid, Spain (J.M.O., A.G.-G., E.C., J.R.-C., R.P.); and Intercenter Congenital Heart Disease Unit, Hospital Virgen del Rocío y Virgen Macarena, Sevilla, Spain (P.G., M.J.R
| | - Raquel Prieto
- From the Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain (P.Á., J.M.O., R.P., F.S., R.Y., F.F.-A.); Adult Congenital Heart Disease Unit, Hospital Universitario La Paz, Madrid, Spain (J.M.O., A.G.-G., E.C., J.R.-C., R.P.); and Intercenter Congenital Heart Disease Unit, Hospital Virgen del Rocío y Virgen Macarena, Sevilla, Spain (P.G., M.J.R
| | - Fernando Sarnago
- From the Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain (P.Á., J.M.O., R.P., F.S., R.Y., F.F.-A.); Adult Congenital Heart Disease Unit, Hospital Universitario La Paz, Madrid, Spain (J.M.O., A.G.-G., E.C., J.R.-C., R.P.); and Intercenter Congenital Heart Disease Unit, Hospital Virgen del Rocío y Virgen Macarena, Sevilla, Spain (P.G., M.J.R
| | - Raquel Yotti
- From the Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain (P.Á., J.M.O., R.P., F.S., R.Y., F.F.-A.); Adult Congenital Heart Disease Unit, Hospital Universitario La Paz, Madrid, Spain (J.M.O., A.G.-G., E.C., J.R.-C., R.P.); and Intercenter Congenital Heart Disease Unit, Hospital Virgen del Rocío y Virgen Macarena, Sevilla, Spain (P.G., M.J.R
| | - Francisco Fernández-Avilés
- From the Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain (P.Á., J.M.O., R.P., F.S., R.Y., F.F.-A.); Adult Congenital Heart Disease Unit, Hospital Universitario La Paz, Madrid, Spain (J.M.O., A.G.-G., E.C., J.R.-C., R.P.); and Intercenter Congenital Heart Disease Unit, Hospital Virgen del Rocío y Virgen Macarena, Sevilla, Spain (P.G., M.J.R
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31
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Labombarda F, Hamilton R, Shohoudi A, Aboulhosn J, Broberg CS, Chaix MA, Cohen S, Cook S, Dore A, Fernandes SM, Fournier A, Kay J, Macle L, Mondésert B, Mongeon FP, Opotowsky AR, Proietti A, Rivard L, Ting J, Thibault B, Zaidi A, Khairy P. Increasing Prevalence of Atrial Fibrillation and Permanent Atrial Arrhythmias in Congenital Heart Disease. J Am Coll Cardiol 2017; 70:857-865. [DOI: 10.1016/j.jacc.2017.06.034] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 06/13/2017] [Accepted: 06/15/2017] [Indexed: 12/22/2022]
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32
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Lim YM, Uhm JS, Pak HN. Focal Atrial Tachycardia Arising from the Inferior Vena Cava. Yonsei Med J 2017; 58:884-887. [PMID: 28541006 PMCID: PMC5447124 DOI: 10.3349/ymj.2017.58.4.884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 08/22/2016] [Accepted: 08/26/2016] [Indexed: 11/27/2022] Open
Abstract
The inferior vena cava (IVC) is a rare site of focal atrial tachycardia (AT). Here, we report a 20-year-old woman who underwent catheter ablation for anti-arrhythmic drug-resistant AT originating from the IVC. She had undergone open-heart surgery for patch closure of an atrial septal defect 17 years previously and permanent pacemaker implantation for sinus node dysfunction 6 years previously. The AT focus was at the anterolateral aspect of the IVC-right atrial junction, and it was successfully ablated under three-dimensional electroanatomical-mapping guidance. We suspect that the mechanism of this tachycardia was associated with previous IVC cannulation for open-heart surgery.
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Affiliation(s)
- Yeong Min Lim
- Department of Cardiology, Yonsei University Health System, Seoul, Korea
| | - Jae Sun Uhm
- Department of Cardiology, Yonsei University Health System, Seoul, Korea
| | - Hui Nam Pak
- Department of Cardiology, Yonsei University Health System, Seoul, Korea.
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33
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Janson CM, Shah MJ. Supraventricular Tachycardia in Adult Congenital Heart Disease: Mechanisms, Diagnosis, and Clinical Aspects. Card Electrophysiol Clin 2017; 9:189-211. [PMID: 28457235 DOI: 10.1016/j.ccep.2017.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Supraventricular arrhythmias represent a major source of morbidity in adults with congenital heart disease (ACHD). Anatomic variants and post-operative changes contribute to a unique electrophysiologic milieu ripe for the development of supraventricular tachycardia. Intra-atrial reentrant tachycardia is the most prevalent mechanism. Atrioventricular reciprocating tachycardia is common in lesions associated with accessory pathways. Abnormal anatomy complicates the management of atrioventricular nodal reentrant tachycardia. Tachycardia mediated by twin atrioventricular nodes is rare. Focal tachycardias are considerations in the ACHD population. Each of these tachycardia mechanisms is reviewed, focusing on the inherent diagnostic and therapeutic challenges.
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Affiliation(s)
- Christopher M Janson
- Division of Cardiology, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, 3415 Bainbridge Avenue, R1, Bronx, NY 10467, USA.
| | - Maully J Shah
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 34th & Civic Center Boulevard, Philadelphia, PA 19104, USA
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Abstract
Patients with repaired or unrepaired congenital heart anomalies are at increased risk for arrhythmia development throughout their lives, often paralleling the need for reoperations for hemodynamic residua. The ability to incorporate arrhythmia surgery into reoperations can result in improvement in functional class and decreased need for antiarrhythmic medications. Every reoperation for congenital heart disease can be viewed as an opportunity to assess the electrical and arrhythmia substrates and to intervene to improve the arrhythmias and the hemodynamic condition of the patient. The authors review and summarize the operative techniques for arrhythmia surgery that are based on the arrhythmia mechanisms.
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Affiliation(s)
- Barbara J Deal
- Feinberg School of Medicine, Northwestern University, 303 East Chicago Avenue, Chicago, IL 60611, USA.
| | - Constantine Mavroudis
- Johns Hopkins Children's Heart Surgery, Florida Hospital for Children, 2501 N Orange Avenue, Suite 540, Orlando, FL 32804, USA
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de Groot NMS, Bogers AJJC. Development of Tachyarrhythmias Late After the Fontan Procedure: The Role of Ablative Therapy. Card Electrophysiol Clin 2017; 9:273-284. [PMID: 28457241 DOI: 10.1016/j.ccep.2017.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Patients with a Fontan circulation are at a high risk of developing a variety of cardiac dysrhythmias after cardiac surgery. These dysrhythmias are most often supraventricular tachyarrhythmias (SVT), but ventricular tachyarrhythmias (VT) may also occur. Mechanisms underlying SVT are variable, including both ectopic activity and reentry. Over time, successive SVT may be caused by different mechanisms. The acute success rate of ablative therapy of atrial tachyarrhythmias is considerably high yet during long-term follow-up 'recurrences' frequently occur. It is most likely that these 'recurrences' are caused by a progressive atrial cardiomyopathy instead of arrhythmogeneity of prior ablative lesions.
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Affiliation(s)
- Natasja M S de Groot
- Department of Cardiology, Erasmus Medical Center, s'Gravendijkwal 230, Rotterdam 3015CE, Netherlands.
| | - Ad J J C Bogers
- Department of Cardiology, Erasmus Medical Center, s'Gravendijkwal 230, Rotterdam 3015CE, Netherlands
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Combes N, Derval N, Hascoët S, Zhao A, Amet D, Le Bloa M, Maltret A, Heitz F, Thambo JB, Marijon E. Ablation of supraventricular arrhythmias in adult congenital heart disease: A contemporary review. Arch Cardiovasc Dis 2017; 110:334-345. [DOI: 10.1016/j.acvd.2017.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/03/2017] [Accepted: 01/03/2017] [Indexed: 10/19/2022]
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Stirbys P. Neuro-atriomyodegenerative origin of atrial fibrillation and superimposed conventional risk factors: continued search to configure the genuine etiology of "eternal arrhythmia". J Atr Fibrillation 2016; 9:1503. [PMID: 29250260 PMCID: PMC5673319 DOI: 10.4022/jafib.1503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 12/19/2016] [Accepted: 12/22/2016] [Indexed: 01/26/2023]
Abstract
Atrial fibrillation (AF) is the most challenging rhythm disturbance worldwide. Arrhythmia and its behavior represent complex pathogenesis highly opposing to contemporary curative modalities. Increasing age of patients carries a certain level of risk for AF. Some underlying diseases in concordance with aging actually accelerate the occurrence of AF. Underestimated superimposed risk factors - aging plus any known risk factor or condition (hypertension, diabetes etc.) - elicit great interest and concern. In light of these concerns we offer an elaborated universal hypothesis in attempt to elucidate the genuine origin of AF substrate. Putative chronic toxicity - toxins and/or involution related pseudo-toxins potentially generate micro- and macro-structural changes in atrial myocardium thus inciting both intracellular damage (degeneration of myocites, apoptosis) and extracellular fibrotic proliferation (interstitial fibrosis, formation of matrices, degeneration of cells with fibrotic replacement). The co-products of related underlying diseases in cooperation with cellular senescence, endogenous overproduction of specific lipids/lipoproteins and other pro-atherosclerotic and/or inflammatory components generate a total atrial response - vascular/microvascular damage, intracellular and extracellular injuries. These organizational arrangements covering the entire atrial myocardium and perhaps ganglionated plexi/autonomic branches of the nervous system eventually cause clinical havoc - atrial overstretch, atrial adaptation/maladaptation, electromechanical dysfunction, arrhythmias, heart failure, etc. In essence, valvular heart disease potentially evokes similar changes "violating" thin atrial walls to obey the same scenario. Depicted atriomyodegenerative processes most likely represent the true nature of AF substrate development. Available clinical and morphological evidence potentially designates the atriomyodegenerative or plausible neuro-atriomyodegenerative origin of AF. Deductively fusion of reasons rather than purely heterogeneity is responsible for AF induction. Thus, the uniform approach and synoptic vision of clinical and pathohistological entity may offer an alternative or refreshed viewpoint in AF substrate formation.
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Brouwer C, Hazekamp MG, Zeppenfeld K. Anatomical Substrates and Ablation of Reentrant Atrial and Ventricular Tachycardias in Repaired Congenital Heart Disease. Arrhythm Electrophysiol Rev 2016; 5:150-60. [PMID: 27617095 DOI: 10.15420/aer.2016.19.2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Advances in surgical repair techniques for various types of congenital heart disease have improved survival into adulthood over the past decades, thus exposing these patients to a high risk of atrial and ventricular arrhythmias later in life. These arrhythmias arise from complex arrhythmogenic substrates. Substrate formation may depend on both pathological myocardial remodelling and variable anatomical boundaries, determined by the type and timing of prior corrective surgery. Accordingly, arrhythmogenic substrates after repair have changed as a result of evolving surgical techniques. Radiofrequency catheter ablation offers an important therapeutic option but remains challenging due to the variable anatomy, surgically created obstacles and the complex arrhythmogenic substrates. Recent technical developments including electroanatomical mapping and image integration for delineating the anatomy facilitate complex catheter ablation procedures. The purpose of this review is to provide an update on the changing anatomical arrhythmogenic substrates and their potential impact on catheter ablation in patients with repaired congenital heart disease and tachyarrhythmias.
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Affiliation(s)
- Charlotte Brouwer
- Department of Cardiology, Leiden University Medical Centre, The Netherlands
| | - Mark G Hazekamp
- Department of Cardiothoracic Surgery, Leiden University Medical Centre, The Netherlands
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Centre, The Netherlands
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Atrial tachyarrhythmias after atrial switch operation for transposition of the great arteries: Treating old surgery with new catheters. Heart Rhythm 2016; 13:1731-8. [DOI: 10.1016/j.hrthm.2016.03.046] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Indexed: 11/18/2022]
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Wasmer K, Eckardt L. Management of supraventricular arrhythmias in adults with congenital heart disease. Heart 2016; 102:1614-9. [PMID: 27312002 DOI: 10.1136/heartjnl-2015-309068] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 05/23/2016] [Indexed: 01/21/2023] Open
Abstract
Supraventricular arrhythmias are a frequent complication in adults with congenital heart disease (ACHD). The prevalence increases with time since surgery, complexity of the underlying defect, type of repair and older age at surgery. Arrhythmias are the most frequent reason for hospital admission and along with heart failure the leading cause of death. The arrhythmia-associated increase in morbidity and mortality makes their management a key task in patients with ACHD. Intra-atrial re-entry is the most frequent arrhythmia mechanism. Less common arrhythmia mechanisms are supraventricular tachycardias in the presence of an accessory pathway, atrioventricular nodal re-entrant tachycardia or focal tachycardias. Patient management includes stroke prevention, acute termination and prevention of arrhythmia recurrence. Acute treatment depends on patients' symptoms. In cases of haemodynamic instability, immediate cardioversion is warranted. For stable patients, acute treatment includes rate control and termination by antiarrhythmic drugs or electrical cardioversion. Following a symptomatic arrhythmia, catheter ablation or treatment with antiarrhythmic drugs is recommended to prevent recurrences. Advances in mapping and ablation technology are now associated with high success rates of catheter ablation. In patients with a complex substrate recurrence rates of 50% remain high. However, in the presence of side effects and complications associated with long-term antiarrhythmic drug therapy, redo procedures are encouraged by current guidelines.
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Affiliation(s)
- Kristina Wasmer
- Division of Clinical and Experimental Electrophysiology, Department of Cardiology and Angiology, University Hospital Münster, Münster, Germany
| | - Lars Eckardt
- Division of Clinical and Experimental Electrophysiology, Department of Cardiology and Angiology, University Hospital Münster, Münster, Germany
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Abstract
Arrhythmias are common in adults with congenital heart disease and account for a large proportion of hospitalizations. The complex anatomical heterogeneity, often in the presence of a delicate hemodynamic system, presents a significant electrophysiological challenge. This review outlines current clinical practice and advances in maximizing the effectiveness of ablation for arrhythmias in congenital heart patients.
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Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ, Estes NM, Field ME, Goldberger ZD, Hammill SC, Indik JH, Lindsay BD, Olshansky B, Russo AM, Shen WK, Tracy CM, Al-Khatib SM. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia. Circulation 2016; 133:e506-74. [DOI: 10.1161/cir.0000000000000311] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
| | | | | | - Hugh Calkins
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Jamie B. Conti
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Barbara J. Deal
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - N.A. Mark Estes
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Michael E. Field
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Zachary D. Goldberger
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Stephen C. Hammill
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Julia H. Indik
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Bruce D. Lindsay
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Brian Olshansky
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Andrea M. Russo
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Win-Kuang Shen
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Cynthia M. Tracy
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
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Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ, Estes NM, Field ME, Goldberger ZD, Hammill SC, Indik JH, Lindsay BD, Olshansky B, Russo AM, Shen WK, Tracy CM, Al-Khatib SM. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: Executive Summary. Circulation 2016; 133:e471-505. [DOI: 10.1161/cir.0000000000000310] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
| | | | | | - Hugh Calkins
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Jamie B. Conti
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Barbara J. Deal
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - N.A. Mark Estes
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Michael E. Field
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Zachary D. Goldberger
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Stephen C. Hammill
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Julia H. Indik
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Bruce D. Lindsay
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Brian Olshansky
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Andrea M. Russo
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Win-Kuang Shen
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Cynthia M. Tracy
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
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2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: Executive Summary. J Am Coll Cardiol 2016; 67:1575-1623. [DOI: 10.1016/j.jacc.2015.09.019] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ, Estes III NM, Field ME, Goldberger ZD, Hammill SC, Indik JH, Lindsay BD, Olshansky B, Russo AM, Shen WK, Tracy CM, Al-Khatib SM. 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia. Heart Rhythm 2016; 13:e136-221. [DOI: 10.1016/j.hrthm.2015.09.019] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Indexed: 01/27/2023]
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Teuwen CP, Taverne YJHJ, Houck C, Götte M, Brundel BJJM, Evertz R, Witsenburg M, Roos-Hesselink JW, Bogers AJJC, de Groot NMS. Tachyarrhythmia in patients with congenital heart disease: inevitable destiny? Neth Heart J 2016; 24:161-70. [PMID: 26728051 PMCID: PMC4771626 DOI: 10.1007/s12471-015-0797-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The prevalence of patients with congenital heart disease (CHD) has increased over the last century. As a result, the number of CHD patients presenting with late, postoperative tachyarrhythmias has increased as well. The aim of this review is to discuss the present knowledge on the mechanisms underlying both atrial and ventricular tachyarrhythmia in patients with CHD and the advantages and disadvantages of the currently available invasive treatment modalities.
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Affiliation(s)
- C P Teuwen
- Department of Cardiology, Erasmus University Medical Center, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Y J H J Taverne
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - C Houck
- Department of Cardiology, Erasmus University Medical Center, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - M Götte
- Department of Cardiology, Haga Hospital, The Hague, The Netherlands
| | - B J J M Brundel
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
- Department of Physiology, Institute of Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
| | - R Evertz
- Department of Cardiology, University Medical Center St. Radboud, Nijmegen, The Netherlands
| | - M Witsenburg
- Department of Cardiology, Erasmus University Medical Center, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - J W Roos-Hesselink
- Department of Cardiology, Erasmus University Medical Center, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - A J J C Bogers
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - N M S de Groot
- Department of Cardiology, Erasmus University Medical Center, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
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Krause U, Backhoff D, Klehs S, Schneider HE, Paul T. Contact force monitoring during catheter ablation of intraatrial reentrant tachycardia in patients with congenital heart disease. J Interv Card Electrophysiol 2016; 46:191-8. [DOI: 10.1007/s10840-015-0096-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 12/28/2015] [Indexed: 10/22/2022]
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48
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Zhou GB, Hu JQ, Guo XG, Liu X, Yang JD, Sun Q, Ma J, Ouyang FF, Zhang S. Very long-term outcome of catheter ablation of post-incisional atrial tachycardia: Role of incisional and non-incisional scar. Int J Cardiol 2015; 205:72-80. [PMID: 26720044 DOI: 10.1016/j.ijcard.2015.12.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 11/08/2015] [Accepted: 12/12/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND The arrhythmogenicity of right atrial (RA) incisional scar after cardiac surgery could result in atrial tachycardia (AT). Radiofrequency catheter ablation is effective in the treatment of such tachycardia. However, data regarding long-term outcomes are limited. METHODS AND RESULTS A total of 105 patients with prior RA incision who underwent radiofrequency catheter ablation of AT were included. In the first procedure, electroanatomic mapping (EAM) revealed a total of 139 ATs in 105 patients, including 88 cavotricuspid isthmus dependent atrial flutters (IDAFs), 5 mitral annulus reentrant tachycardias (MARTs), 44 intra-atrial reentrant tachycardias (IARTs) and 2 focal ATs (FATs). AT was successfully eliminated in 101 (96.1%) patients. During a mean follow-up period of 90 ± 36 months, recurrent AT was observed in 23 patients and 21 underwent a second ablation. A total of 23 ATs were identified in redo procedures including 4 IDAFs, 2 MARTs, 12 IARTs and 5 FATs. The time to recurrence was significantly different among various AT types. Acute success was achieved in 20 of 23 redo procedures. Taking a total of 21 patients presenting atrial fibrillation during follow-up into account, 85 patients (81.9%) were in sinus rhythm. No complications except for a case of RA compartmentation occurred. CONCLUSION RA incisional scar played an essential role in promoting both IDAF and IART, while non-incisional scar contributed to a substantial rate of late recurrent AT in forms of both macroreentry and small reentry. Catheter ablation using EAM system resulted in a high success rate during long-term follow-up.
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Affiliation(s)
- Gong-Bu Zhou
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ji-Qiang Hu
- Department of Cardiology, Oriental Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xiao-Gang Guo
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xu Liu
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian-du Yang
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qi Sun
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian Ma
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Fei-Fan Ouyang
- Department of Cardiology, Asklepios Klinik St Georg, Hamburg, Germany
| | - Shu Zhang
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Lindsay I, Moore JP. Cardiac Arrhythmias in Adults With Congenital Heart Disease: Scope, Specific Problems, and Management. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2015; 17:56. [DOI: 10.1007/s11936-015-0418-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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